Psychiatric Mental Health Nursing Test Part 1

All the questions in the quiz along with their answers are shown below. Your answers are bolded. The correct answers have a green background while the incorrect ones have a red background. 1. Your patient is very dependent and submissive. There are times that the patient is very clingy. This behavior reflects what type of personality disorder?  a. Antisocial personality  b. Dependent Personality 

c. Manic behavior d. Anxiety disorder Dependent personality is characterized by dependence, submission and being clingy. Antisocial personality is impulsive, aggressive and manipulative.

2. The appropriate therapeutic distance between you and a psychiatric patient is?  a. 12 inches  b. 35 inches 

c. 12 feet d. 4 feet Intimate zone: 0-18 inches. Parents with young children, people who mutually desire personal contact, or people whispering. Personal zone: 18-36 inches. Between family and friends talking. Social zone: 4-12 feet. Communication in social, work and business settings. Public zone: 12-25 inches. Speaker and an audience. Therapeutic distance: 3-6 feet. 3. Nurse Anna is instructing the new nurse to the psychiatric set-up. She also reminded her to use her therapeutic

communication skills in dealing with clients. Which of the following techniques enlaces therapeutic communication?  a. What are you thinking about?  b. What made you think that way?  c. Why did you say that? 

d. Let¶s not talk about that. What do you think? This is using the therapeutic technique BROAD OPENING that allows the client to take the initiative to introduce a topic.

4. Mr. Juan is diagnosed with Alzheimer¶s disease. The nurse¶s intervention should focus on helping the client be oriented with the physical set-up and daily events. Which of the following is the most effective nursing intervention in orienting patients who has Alzheimer¶s disease?  a. Encourage the client to talk to family members to reminisce things 


b. Provide simple and easily understood directions c. Perform tasks with a variety of activities each day d. Have the client socialize with other patients Providing a daily routine and directions easily understood by the client would help orienting a client with Alzheimer¶s disease. 5. A therapy that focuses on the remotivation of clients by directing their attention outside themselves to relieve preoccupation with personal thoughts, feelings, and attitudes is known as: 

a. Pharmacologic therapy


b. Music therapy c. Occupational therapy

d. Recreational therapy Recreational therapy- Focuses on remotivation of clients by directing their attention outside themselves to relieve preoccupation with personal thoughts, feelings, and attitudes. Clients learn to cope with stress through activity. Activities are planned to meet specific needs and encourage the development of leisure-time activities or hobbies. Recreational therapy is especially useful with those people who have difficulty relating to others (e.g., the regressed, withdrawn, or immobilized person). Examples of recreational activities include group bowling, picnics, sing-along, and bingo.

6. The 12-year old male patient looks like the nurse¶s younger brother who is missing for years. During assessment and in the implementation of nursing care the nurse prioritizes this client. One day, when she found the boy crying in his room she hugged him and cried with him. This is an example of:  a. Counter-transference 


b. Transference c. Resistance d. Denial When the nurse displays affection or emotion toward the client counter-transference is occurring. Transference is observed when the patient is displaying emotions towards the nurse. 7. A schizophrenic client is under your care. In reinforcing the functional behavior of this client what will the nurse do? a. Enumerate the symptoms of schizophrenia to the client 


b. Correct delusional thoughts to orient to reality c. Compliment the client for cessation of acting out behaviors d. Encourage the client to drink his medications religiously According to B.F. Skinner¶s behavior medication technique, a client should be praise for good behaviors to help him

modify his faulty actions. 8. A client was brought to the ER. Based on the significant others, the client had a history of shop stealing. However, no self-mutilating activities are committed by the client. During the interview, the client is very manipulative and 


aggressive and impulsive. What personality disorder most likely the client has? a. Antisocial b. Histrionic c. Narcissistic d. Borderline Antisocial P.D is characterized by aggression, manipulation and impulsivity. Histrionic people are emotional, dramatic and theatrical. Narcissistic people are boastful, egotistical and have superiority complex. Borderline PD is characterized by impulsivity, self-destruction and very unstable mood. 9. When the client told the nurse that he feels good when he mutilates or cuts himself the novice psychiatric nurse answered, ³Do you know the risks involved when you cut yourself?´ what type of nontherapeutic communication is the nurse using? 


a. Defending b. Testing c. Making stereotyped comments d. Disagreeing

Testing is appraising a client¶s degree of insight such as by asking the patient of the risks involved when he cut himself. This forces the client to recognize his problems. Defending is attempting to protect someone from a verbal attack. Stereotyped comments are meaningless clichés such as ³it¶s for your own good.´ 10. A therapy that assists with discharge planning and rehabilitation, focusing on vocational skills and activities of daily living (ADL) to raise self-esteem and promote independence is called: 


a. Behavior modification b. Milieu therapy c. Recreational therapy d. Occupational therapy

Occupational therapy - Assists with discharge planning and rehabilitation, focusing on vocational skills and activities of daily living (ADL) to raise self-esteem and promote independence 11. Nurse Marie is caring for a patient that underwent alcohol detoxification. Which of the following symptoms would Nurse Marie be most concern? 


a. Fever b. Delusions c. Excessive sweating d. Increase BP

Once hallucinations and delusions are present; the client¶s condition will most likely progress to delirium tremens. 12. The Distance that is observed when family members or friends are talking is under what zone: a. Intimate b. Therapeutic c. Personal d. Social Personal zone: 18-36 inches. Between family and friends talking. Intimate zone: 0-18 inches. Parents with young 


children, people who mutually desire personal contact, or people whispering. Social zone: 4-12 feet. Communication in social, work and business settings. Therapeutic distance: 3-6 feet. 13. The client is sharing Nurse Marie about his experiences. Suddenly, he paused, looked to the nurse and is hesitant to continue. The nurse responded, ³Go on, and tell me about it.´ What therapeutic communication technique is the nurse using?  a. Exploring  b. Focusing 

c. Encouraging expression d. General leads General leads indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. They also encourage the client to continue if he or she is hesitant or uncomfortable of the topic. Examples include, ³Go on,´ ³Tell me about it,´ and ³And then?´

14. In a therapeutic communication, ³why questions´ are discouraged. For what reason is this question not useful?  a. The question is intimidating and the client may be defensive in trying to explain him/herself. 


b. It forces the client to recognize his or her problems. The client¶s acknowledgement that s/he doesn¶t know things may be helpful to the nurse¶s needs but not the client. c. It indicates that the client is right rather than wrong. d. It tends to make the client used and invaded.

Using ³why question´ is asking to client the client to provide reasons for thoughts, feeling and behaviors. The question is intimidating and the client may be defensive in trying to explain him/herself.

This type of communication can indicate the speaker¶s thoughts. d. ³I don¶t want to hear about that!´ c. In using a therapeutic communication technique interpreting client cues and signals is very important. ³I want to die. feelings. An 18 year old client is brought to the ER due to a suicidal attempt.´ d. the client told the nurse that cutting himself feels great. Close monitoring Safety is the most important consideration in client with a suicidal attempt. eye contact. ³What are you doing here?´ Concrete messages are patterns of words that the nurse uses where words are explicit and does need an explanation. 16. ³Tell me more about that. c. needs and values that he or she acts out unconsciously. A behavior that can indicate the speaker¶s thoughts. Abstract messages c. One day during one of the sessions.harming behaviors c. feelings. Her mother told the nurse that she has been drinking alcohol for the last 3 weeks and is depressed.15. needs and values that he or she acts out unconsciously is called:     a.´ Covert cues are vague or hidden messages such as if a client verbalizes. speed and hesitations in speech. Administering antidepressant medications  b. Punishment for stealing the other client¶s things   b. Concrete messages d. 19. facial expression. Allowing the client to participate in a therapy d. What would be the nurse¶s best response?  a. Verbal abuse . In caring for this patient what is the most important consideration?  a. ³The behavior of cutting is not acceptable. Alcohol detoxification   c. Restraints are only used for a certain reason.´ Abstract messages are unclear patterns of words that often contain figures of speech that are difficult to interpret. 17. Which of the following is an appropriate reason for placing a client in restraints?  a. grunts and groans and distance from the listeners. ³Do you know the risks involved when you cut yourself?´    b. A client was admitted due to self-mutilation. This is achieved by removing harmful objects around the client and monitoring the client closely. Self. Example is when the nurse asked the client. Overt cues Overt cues are clear statements of intent such as the client saying. ³No one can help me. b. 18. Asking the client to tell the nurse more about is validating the actions of cutting himself. Verbal communication Communication Nonverbal communication Congruent message Nonverbal communication is the behavior that accompanies verbal content such as body language.´ Presenting reality is the best in this situation as it is obvious that the client is misinterpreting the reality. Clear statements of intent such as the client saying that he wants to kill himself is a/an:  a. tone of voice. Covert cues    b.

25. A signed informed consent of a 23-year old client¶s parent d. A signed informed consent by a 23-year old client who has voluntarily admitted himself in the unit. Which of the following must be accomplished?  a. ³What are the voices telling you?´ d. Leave the client in the room for the whole 8 hours  b. how should his medication dosage be adjusted?   a. limitations. Same medication dose b. 22. Because if the voices are telling the client to kill himself or someone safety precautions must be implemented. Epinephrine   c. 20. c. What is nurse¶s initial response?  a. If a client is a chain smoker.´  b. restraints is acceptable. risks and outcome and has been informed of the other alternative therapy. 23. 24. monitor the extremity circulation When a client is placed on restraint. If a client is on restraints which of the following would the nurse do?  a. being aware of what his/her strengths. Take pictures of the client for evaluation d. A signed informed consent by a 17-year old client Clients of legal age can sign an informed consent. Salary rate    b. ³Are you sure about that?´ Initially the nurse has to assess what the voices are telling the client to promote safety. Atropine  b. Which of the following medications can be given to the client before the procedure?  a. ³From where are those voices coming from?´   c. Self-understanding d. Not drinking medications One the patient attempts to harm himself. Increase the dose . A nurse who barely knows and understand herself cannot effectively establish a therapeutic communication with psychiatric clients. weaknesses. Self-awareness c. monitor the circulation to prevent physiologic damage of the extremity. 21. Do not allow the client to eat   c. Atropine is antiarrythmic and at the same time an anticholinergic medication. To ensure that your client knows about the procedure. A signed informed consent by a client¶s family member    b. ³I don¶t hear any voices. Standard of nursing practice Before a nurse can understand him/herself. Phenobarbital Before ECT atropine can be given to the client to decrease oral and respiratory function thereby preventing risks of aspiration. The client says that he is hearing voices. A client is scheduled for an electroconvulsive therapy (ECT). What is the most important criteria that must be accomplished by the nurse before dealing with psychiatric patients?  a. d. Hydralazine d. belief and principles is very essential.

Decrease the dose d. . thus. Withhold the dose Smoking cigarettes increases the metabolism of some psychiatric medications. medication dose should be increased.  c.

intentional behavior that the client performs in response to a certain obsession. Demonstrate decreased anxiety. Participate in a daily exercise group. A female client comes to the emergency department while experiencing a panic attack. Implying that the client's behavior is tiring. Talking continually to the client by explaining what is happening The nurse should remain with the client until the attack subsides. Depression  c. "It's foolish to change clothes so many times in one day. Nurse Jonathan can best     respond to a client having a panic attack by: a. A compulsion is a repetitive." c. Increased anxiety An obsessive-compulsive client who attempts to resist the compulsion must be evaluated for increased anxiety. Based on this finding. 4. Resisting the compulsion may increase the client's anxiety. so the nurse should use short phrases and slowly give one direction at a time. Feelings of failure  b.Psychiatric Mental Health Nursing Test Part 2 All the questions in the quiz along with their answers are shown below. Nurse Krishna notices that a female client with obsessive-compulsive disorder dresses and undresses numerous times each day.   c. Option A isn't stated specifically enough to allow for evaluation. specific objectives must be stated such as. Your answers are bolded. helping to reduce the intensity of the ritualistic behavior and promoting trust and rapport. Which comment by the nurse would be most therapeutic?     a. If the client is left alone he may become more anxious. 1." Option C is incorrect because identifying the . the nurse should assess the client for:  a. 2.  b. these aren't responses to resisting the compulsion. "It bothers me to see you always so busy. "Try to dress only once per day so you won't be so tired. and excessive fear. "I saw you change clothes several times today. The correct answers have a green background while the incorrect ones have a red background. Nurse Luz is formulating a short-term goal for a client suffering from a severe obsessive-compulsive disorder (OCD). or foolish would convey disapproval. 3. depression." b. d. Identify the underlying reasons for rituals." Option A focuses on the client's feelings in an empathetic way. Telling the client everything is under control c. impede trust and rapport. it's aimed at neutralizing or decreasing anxiety. Although a client with OCD may have feelings of failure. Participating in a daily exercise group refocuses the client's time toward adaptive activities and may reduce anxiety. Giving false reassurance is inappropriate in this situation. State that the rituals are irrational. bothersome. The client may be so overwhelmed that he can't follow lengthy explanations or instructions. and worsen anxiety. That must be very tiring. An appropriately stated short-term goal is that after 1 week. promote dysfunctional behavior. "The client will verbalize feeling less anxious. for this goal to be measurable. Telling the client to lie down and rest d. Staying with the client until the attack subsides b. the client will:  a. Nurse Renalyn discovers that a male client with obsessive-compulsive disorder (OCD) is attempting to resist the compulsion. The client should be allowed to move around and pace to help expend energy. Excessive fear  d." d.

underlying reasons for rituals takes time and isn't a realistic goal after 1 week. Most clients with OCD are aware that the ritual is irrational but can't stop it, making option D inappropriate as well. 5. Because antianxiety agents such as chlordiazepoxide (Librium) can potentiate the effects of other drugs, nurse Raquel should incorporate which of the following instructions in her teaching plan?  a. Avoid mixing antianxiety agents with alcohol or other central nervous system (CNS) depressants 


b. Avoid taking antianxiety drugs at bedtime c. Avoid taking antianxiety drugs on an empty stomach d. Avoid consuming aged cheese when taking antianxiety agents Potentiating effect refers to a drug's ability to increase the potency of another drug if taken together. Therefore, the client should be instructed to avoid alcohol while taking Librium because it potentiates the drug's CNS depressant effect. Taken at bedtime, this drug will induce sleep. Librium comes in capsule form and usually can be taken with water. Aged cheese is restricted with monoamine oxidase inhibitors, not Librium.

6. Danilo, arrives on the psychiatric unit exhibiting extreme excitement, disorientation, incoherent speech, agitation, frantic and aimless physical activity, and grandiose delusion. Which nursing diagnosis takes highest priority for the client at this time?  a. Ineffective individual coping 


b. Hopelessness c. Risk for injury d. Disturbed identity This client is at increased risk for injury because of severe hyperactivity, disorientation, and agitation. Although the

other options also are appropriate, the client's safety takes highest priority. The nurse should take immediate action to protect the client from injury. 7. Gina, age 18, is highly dependent on her parents and fears leaving home to go away to college. Shortly before

the fall semester starts, she complains that her legs are paralyzed and is rushed to the emergency department. When physical examination rules out a physical cause for her paralysis, the physician admits her to the psychiatric unit where she is diagnosed with conversion disorder. The client asks nurse Rose, "Why has this happened to me?" What is the nurse's best response? 


a. "You've developed this paralysis so you can stay with your parents. You must deal with this conflict if you want to walk again." b. "It must be awful not to be able to move your legs. You may feel better if you realize the problem is psychological, not physical." c. "Your problem is real but there is no physical basis for it. We'll work on what is going on in your life to find out why it's happened." d. "It isn't uncommon for someone with your personality to develop a conversion disorder during times of stress."

The nurse must be honest with the client by telling her that the paralysis has no physiologic cause while also conveying empathy and acknowledging that her symptoms are real. The client will benefit from psychiatric treatment, which will help her understand the underlying cause of her symptoms. After the psychological conflict is resolved, her symptoms will disappear. Saying that it must be awful not to be able to move her legs wouldn't answer the client's question; knowing that the cause is psychological wouldn't necessarily make her feel better. Telling her that she has developed paralysis to avoid leaving her parents or that her personality caused her disorder wouldn't help her understand and resolve the underlying conflict. 8. Dr. Luistro orders a new medication for a client with generalized anxiety disorder. During medication teaching, which statement or question by the nurse Kesselyn would be most appropriate?


a. "Take this medication. It will reduce your anxiety." b. "Do you have any concerns about taking the medication?"

c. "Trust us. This medication has helped many people. We wouldn't have you take it if it were dangerous." d. "How can we help you if you won't cooperate?" Providing an opportunity for the client to express concerns about a new medication and to make a choice about taking it can help the client regain a sense of control over his life. The client has the right to refuse the medication. Instead of simply ordering the client to take it, as in option A, the nurse should provide the information the client needs to make an informed decision. Attempting to make the client feel guilty, as in option C, or threatening the client, as in option D, would increase anxiety.

9. After seeking help at an outpatient mental health clinic, a client who was raped while walking her dog is diagnosed with posttraumatic stress disorder (PTSD). Three months later, the client returns to the clinic, complaining of fear, loss of control, and helpless feelings. Which nursing intervention is most appropriate for this client?  a. Exploring the meaning of the traumatic event with the client 


b. Allowing the client time to heal c. Giving sleep medication, as prescribed, to restore a normal sleep-wake cycle d. Recommending a high-protein, low-fat diet The client with PTSD needs encouragement to examine and understand the meaning of the traumatic event and consequent losses. Otherwise, symptoms may worsen and the client may become depressed or engage in selfdestructive behavior such as substance abuse. The client must explore the meaning of the event and won't heal without this, no matter how much time passes. Behavioral techniques, such as relaxation therapy, may help decrease the client's anxiety and induce sleep. The physician may prescribe antianxiety agents or antidepressants cautiously to avoid dependence; sleep medication is rarely appropriate. A special diet isn't indicated unless the client also has an eating disorder or a nutritional problem. 10. Jane is admitted to an inpatient psychiatric unit for treatment of obsessive-compulsive symptoms. Obsessive-

compulsive disorder (OCD) is associated with:  a. Physical signs and symptoms with no physiologic cause  b. Apprehension  c. Inability to concentrate 

d. Repetitive thoughts and recurring, irresistible impulses OCD is characterized by repetitive thoughts that the client can't control or exclude from consciousness, along with recurring, irresistible impulses to perform a particular action. Physical signs and symptoms with no physiologic cause typify somatoform disorder. Apprehension and inability to concentrate characterize anxiety disorders. 11. A client with obsessive-compulsive disorder and ritualistic behavior must brush the hair back from his forehead 15 times before carrying out any activity. Nurse Leo notices that the client's hair is thinning and the skin on the forehead is irritated ² possible effects of this ritual. When planning the client's care, the nurse should assign highest 


priority to: a. Helping the client identify how the ritualistic behavior interferes with daily activities b. Exploring the purpose of the ritualistic behavior c. Setting consistent limits on the ritualistic behavior if it harms the client or others d. Using problem solving to help the client manage anxiety more effectively Client safety is the paramount concern and must be maintained. Therefore, setting consistent limits on potentially harmful ritualistic behavior takes highest priority. Although the other options are important, they take lower priority. For instance, helping the client identify how the ritualistic behavior interferes with daily activities increases the client's motivation for using more effective coping behavior. Exploring the purpose of the ritualistic behavior helps the client

see this behavior as an attempt to control anxiety. As the client learns new ways to manage anxiety, the ritualistic behavior is likely to decrease. 12. During alprazolam (Xanax) therapy, nurse Rachel should be alert for which dose-related adverse reaction? a. Ataxia b. Hepatomegaly 


c. Urticaria d. Rash Dose-related adverse reactions to alprazolam include drowsiness, confusion, ataxia, weakness, dizziness, nystagmus, vertigo, syncope, dysarthria, headache, tremor, and a glassy-eyed appearance. These dose-related reactions diminish as therapy continues. Although hepatomegaly may occur with benzodiazepine use, this adverse reaction is rare and isn't dose-related. Idiosyncratic reactions to benzodiazepines may include a rash and acute hypersensitivity reactions; however, they aren't dose-related.

13. A client is admitted to the psychiatric unit with a diagnosis of conversion disorder. Since witnessing the beating of his wife at gunpoint, he has been unable to move his arms, complaining that they are paralyzed. When planning the client's care, nurse Jay should focus on:  a. Helping the client identify and verbalize feelings about the incident 


b. Convincing the client that his arms aren't paralyzed c. Developing rehabilitation strategies to help the client learn to live with the disability d. Talking about topics other than the beating to avoid causing anxiety In conversion disorder, the client represses and converts emotional conflicts into motor, sensory, or visceral

symptoms with no physiologic cause. Interventions should focus on helping the client identify the underlying emotional problem. A client with conversion disorder can't be convinced that the physical problem isn't real; attempts to convince him may lead him to seek other health care providers who may accept the reality of his symptoms. Treating the physical symptoms as long-term or permanent may encourage the client to maintain them. Ignoring the cause of the symptoms would prevent the client from dealing with his feelings about his wife's beating. 14. A male client with borderline personality disorder tells nurse Valerie, "You're the only nurse who really understands me. The others are mean." The client then asks the nurse for an extra dose of antianxiety medication 


because of increased anxiety. How should the nurse respond? a. "I'll talk to the physician right away. I don't think they give you enough medicine." b. "I'll have to discuss your request with the team. Can we talk about how you're feeling right now?" c. "I don't want to hear you say negative things about the other nurses."

d. "You know you can't have extra medication. Why do you keep asking?" This response appropriately focuses on the emotional content of the client's message and helps the client identify feelings. Focusing on the request for extra medication would allow the client to ignore the underlying emotional issues. Clients with borderline personality disorder commonly divide the staff into "good guys" and "bad guys" to meet their needs; staff members must maintain consistency and a united front at all times. The nurse shouldn't take the client's statements personally because this would interfere with the ability to maintain a therapeutic relationship. 15. Angel, is admitted to the unit visibly anxious. When assessing her, the nurse would expect to see which of the

following cardiovascular effects produced by the sympathetic nervous system?  a. Syncope  b. Decreased blood pressure  c. Increased heart rate 

d. Decreased pulse rate

She tells nurseAngelie she is worried about how she'll continue to care for him. focusing on their needs. Leaving the client alone until he can talk about his feelings d. An agitated and potentially violent client shouldn't be left alone or unsupervised because the danger of the client's acting out is too great. and disorientation. At this time. the nurse should provide single. The nurse should use restraints only when required to prevent self-harm by the client. Provide the client with detailed instructions    b. 125 mg by mouth daily. Keep the client sedated whenever possible c."   b. and peripheral vasoconstriction. such as bottles of hydrogen peroxide and benzoin. the nurse can diffuse impending violence by helping the client identify and express feelings of anger and anxiety. rather than many detailed instructions. 16. Involving the client in a quiet activity to divert attention c.Sympathetic cardiovascular responses to stress include increased heart rate. for 1 week. cardiac contractility. children. increased blood pressure. "Imipramine may not be the most effective medication for you. Unlocked seclusion can be helpful for some clients because it reduces environmental stimulation and provides a feeling of security. The nurse must tailor care to the client and family. where his identification is eventually discovered. Placing the client in seclusion In many instances. "Because imipramine must build to a therapeutic level. Syncope is a response to parasympathetic stimulation. Which response by the nurse would be most helpful?     a. The client's wife states that he was diagnosed with Alzheimer's disease 3 years ago and has had increasing memory loss. "The physician may need to increase the dosage for you to get the medication's maximum benefit. Helping the client identify and express feelings of anxiety and anger    b. Remove hazards from the environment d. Nurse Agnes is aware that nursing action most appropriate when trying to diffuse a male client's impending violent behavior?  a. He is brought to the emergency department. it may take 2 to 3 weeks to reduce depression. Such statements as "What happened to get you this angry?" may help the client verbalize feelings rather than act on them. You should call your physician for further evaluation. A male client with Alzheimer's disease has a nursing diagnosis of Risk for injury related to memory loss. The nurse should administer medication as prescribed and as needed ² not to keep the client sedated. Jumping to conclusions regarding the client's need for a nursing home or other care placement options would be inappropriate. and friends may prove helpful to the client's wife. you should start looking into nursing homes for him. For a client with Alzheimer's disease. 19. 17. Rudy was found wandering in a local park is unable to state who or where he is or where he lives." . "Do you have any children or friends who could give you a break from his care every now and then?" The nurse should determine the specific concerns of the client's wife. the nurse must establish a plan for continued care that addresses her specific concerns. what is the best response of nurse Charlyn?  a. wandering. The client should be placed in seclusion only if other interventions fail or the client requests this." d. "What aspect of caring for your husband is causing you the greatest concern?" c. A male client has been taking imipramine (Tofranil). Which nursing intervention should appear in this client's plan of care to prevent injury?  a. simple instructions. "You may benefit from a support group called Mates of Alzheimer's Disease Clients. the nurse can help prevent injury to the client. 18." c. Close interaction with the client in a quiet activity may place the nurse at risk for injury should the client suddenly become violent. Use restraints at all times By removing environmental hazards. Although support groups. Now the client reports wanting to stop taking the medication because he still feels depressed." b. and cardiac output. "Because of the nature of your husband's disease.

or cardiac stress testing. because this activity is familiar. and aerobic exercise are too complicated for a confused client. Although ECT may reduce the severity of depression. neurologic examination. usually about 2 to 3 weeks after the initial dose. 22. 20. it . nurse Mark should encourage the client to:  a. Nurse Francis is aware that the nursing preparations for a client undergoing electroconvulsive therapy (ECT) resemble those used for:     a. these preparations aren't indicated for a client undergoing physical therapy. nurse Bernadeth should include which most important point about ECT?  a. Ipecac syrup c. Cards. Simethicone (Phazyme) d. Neurologic examination c. the nurse may use the other responses. glasses. Warfarin sodium (Coumadin) b. ECT can cure depression   c. such as imipramine. Usually. and make sure the client is wearing a hospital gown or loose-fitting clothing to allow unrestricted movement. According to ECT proponents. Also. the nurse should encourage the client to continue therapy at least until the drug reaches that level. the client should receive nothing by mouth for 8 hours before ECT to reduce the risk of vomiting and aspiration. ECT is administered by a physician or an anesthesiologist. don't produce antidepressant effects until they reach a therapeutic level in the blood. Perform an aerobic exercise Folding towels and pillowcases is a simple activity that redirects the client's attention. the nurse should have the client void before treatment to decrease the risk of involuntary voiding during the procedure. ECT will induce a seizure d." Antidepressant agents. remove any full dentures. To help redirect the client's attention. Famotidine (Pepcid) Ipecac syrup is rendered inactive when administered concomitantly with activated charcoal. A male client with Alzheimer's disease mumbles incoherently and rambles in a confused manner. After this time. Also. Dr. the client is likely to perform it successfully. Cardiac stress testing The nurse should prepare a client for ECT in a manner similar to that for general anesthesia. the seizure causes desirable changes in neurotransmitters and receptor sites similar to those caused by antidepressant drugs. Fold towels and pillowcases  b. charades. Nurse Hershey must administer activated charcoal before administering certain other drugs to a client who's     taken an overdose. Participate in a game of charades d. Therefore. Which drug is rendered inactive when administered concomitantly with activated charcoal? a. or jewelry to prevent breakage or loss. d. therapy. 21. For example. General anesthesia d. Play cards with another client   c. An anesthesiologist will administer ECT  b. Physical therapy b. if the client's depression doesn't abate. "Don't stop taking the medication abruptly because you may develop serious adverse effects. ECT is the passage of an electrical current through the brain to induce a brief seizure. When teaching the client and family about this treatment. Tan orders electroconvulsive therapy (ECT) for a severely depressed client who fails to respond to drug 23. The client will remember the shock of ECT but not the pain Reserved for clients with acute depression who don't respond to pharmacologic or psychiatric measures.

an adolescent becomes increasingly withdrawn. The client has received lithium carbonate (Lithonate) Before an ECT treatment. a chest X-ray. Nurse Bea is aware the when preparing a client for electroconvulsive therapy (ECT). After giving away a stereo and some favorite clothes. The client sees family members immediately before the procedure    b. This adolescent is at risk for:     a. neurologic and laboratory tests. Lithium must be discontinued before ECT because it prolongs the effects of succinylcholine chloride (Anectine). the nurse should ensure that the client has had a medical evaluation that includes an ECG. if indicated. she should make sure that:  a. This adolescent's signs and symptoms don't suggest fear of school and typify depression.doesn't necessarily cure it. and spinal X-rays. the adolescent is brought to the community mental health agency for evaluation. 25. is irritable with family members. . The client has undergone a thorough medical evaluation d. a muscle relaxant given just before the shock is delivered. not psychosis. Psychotic break Changes in academic performance and familial communications. Anorexia nervosa would cause weight loss and other related symptoms. Before ECT. A brain scan isn't required after ECT because it can't evaluate the therapeutic effects of this treatment. social withdrawal. it's unnecessary (unless the client requests this). Julius. Although making sure that the client sees family members immediately before the procedure would be appropriate. Anorexia nervosa c. Suicide b. School phobia d. The client is scheduled for a brain scan immediately after the procedure c. the client receives a medication that provides short-term amnesia of the entire event. 24. and has been getting lower grades in school. and giving away of treasured possessions suggest that this adolescent is contemplating suicide.

However. Imipramine is started at 50 to 75 mg daily and. every morning. doxepin (Sinequan). amitriptyline (Elavil).Psychiatric Mental Health Nursing Test Part 3 All the questions in the quiz along with their answers are shown below. Lithium derivative Physicians prescribe venlafaxine to treat depressive disorders. cardiovascular complications. Amitriptyline is usually started at 75 to 150 mg P. 1. the drug is a second-generation antidepressant agent 4. Doxepin is started at 25 to 50 mg daily and may be titrated upward to a maximum daily dose of 300 mg. 500 mg daily  d. Seizures may be a later sign of lithium toxicity.O. Sexual dysfunction  b. Constipation  c. awakening them. such as antipsychotic drugs. Lock the client's door at bedtime In geriatric clients. Diarrhea. A male adult client with bipolar disorder is being treated with lithium for the first time. titrated upward to a maximum daily dose of 300 mg. Victor a geriatric client with senile dementia wanders into other clients' rooms. Monoamine oxidase inhibitor  b. At night. After the physician diagnoses acute depression. 20 mg by mouth (P. paroxetine (Paxil). 20 mg P. Tricyclic antidepressant  c.O. and can barely perform basic self-care activities. is the only correct dosage. 3. it's more common with sedatives and tricyclic antidepressants.O. Velasquez is brought to the crisis intervention center by his wife. Nurse Vanessa is administering venlafaxine (Effexor) 75 mg by mouth daily to a client diagnosed with depression. the nurse should anticipate administering:  a. Seizures Polyuria commonly occurs early in the treatment with lithium and could result in fluid volume deficit. eats little. Sexual dysfunction isn't a common adverse effect of lithium. occurs with lithium. 20 mg P. Polyuria  d. imipramine (Tofranil). 2. Your answers are bolded. Benzodiazepines usually are avoided because of the risk of addiction. She reports that he sleeps poorly. She also reveals that 3 months ago he was in a car accident in which his best friend was killed. Administer a phenothiazine at bedtime as prescribed  c. not constipation. Administer a barbiturate at bedtime as prescribed  d. The correct answers have a green background while the incorrect ones have a red background.) every morning  b. paroxetine. phenothiazines are preferred for sedation and thought clearing. Nurse Joy should observe the client for which common adverse effect of lithium?  a. and impaired motor coordination.O. daily  c. daily in divided doses. if tolerated. 500 mg daily All of the drugs listed are antidepressants that may be prescribed for this client.Constipation can occur with other psychiatric drugs. Administer a benzodiazepine at bedtime as prescribed  b. who states that he has been increasingly listless and less involved with his family recently. Barbiturates . What is the best nursing intervention for dealing with the client's insomnia and nocturnal roaming?  a. What type of agent is venlafaxine?  a. Second-generation antidepressant  d. Mr.

Encourage the client to discuss his fear of having a serious illness. An ambulance was called and the client was taken to the emergency department.   c. Now that the client is feeling better. A therapeutic relationship should be initiated upon admission to the psychiatric unit. The client wears a hospital gown instead of street clothes. a new contract should be obtained from the client. the nurse must continue to be vigilant to the risk of suicide. d. Which behavior suggests that the client is recovering from depression?  a. d. Because of the risk of missing an actual medical problem. any new symptoms reported by a client with hypochondriasis should be reported to the physician. Cancel any no-suicide contracts. Determine if the illness is fulfilling a psychological need for the client. As the client's energy level increases. after suicide precautions have been instituted. . 5.  b. By talking about returning to college. Report the complaint of chest pain to the physician. It's through this relationship that the client develops feelings of self-worth and trust and problem-solving takes place. a 54-year-old was found unconscious on the floor of her bathroom with self-inflicted wrist lacerations. Don't take with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). How should the nurse react initially?  a. Avoid strenuous activity because of the cardiac effects of the drug. A chest X-ray and skin test are negative for tuberculosis. Don't take prescribed or over-the-counter medications without consulting the physician. Locking the door is inappropriate and would violate the client's rights. The client begins to complain about the sudden onset of chest pain. The client attributes his cough to tuberculosis. The other interventions are appropriate after the nurse has determined that the client doesn't have a serious medical disorder. Let the client know the nurse understands his fears of serious illness. which is a sign of recovery from depression. Observe for extrapyramidal symptoms. The client talks about the difficulties of returning to college after discharge    b. Which of the following statements should be included when teaching a male client about monoamine oxidase inhibitor (MAOI) antidepressants?  a.  b. Extrapyramidal symptoms may occur with antipsychotics and aren't adverse effects of antidepressants. 6. which nursing intervention is most appropriate?  a. Linda. she may have the energy to initiate and complete another suicide attempt. the client was transferred to the inpatient psychiatric unit for observation and treatment with antidepressants.  c. In a no-suicide contract.   c. Begin a therapeutic relationship. excitement.  b. The client spends most of the day sitting alone in the corner of the room. Have blood levels screened weekly for leukopenia. Nurse Mary Anne is caring for a client who has been diagnosed with hypochondriasis. When the time period for a contract has expired. the client states verbally or in writing that she won't attempt suicide and will seek out staff if she has suicidal thoughts.also are avoided because they may cause delirium. 8. Continue suicide precautions As antidepressants begin to take effect and the client feels better. lack of interest in personal appearance. 7. the client is demonstrating an interest in making plans for the future. Catherine has received treatment for depression for 3 weeks. Decreased socialization. and lack of emotion are all symptoms of depression.  d. When she was stable. The client shows no emotion when visitors leave. d. and addiction. confusion. c.

. a respiratory rate of 20 breaths/minute. survivor's guilt b. Angelo with a diagnosis of major depression is prescribed clonazepam (Klonopin) for agitation in addition to an antidepressant. or feeling from consciousness.    b.9° C). 9. call the physician. Because the client also is confused and incontinent. d. nurse Ronie suspects malignant neuroleptic syndrome. For several years. Anticipatory grief occurs when an individual experiences grief before a loss occurs. Decrease the dosage if signs of illness decrease. Give the next dose of fluphenazine. Increase the dosage up to 50 mg twice per day if signs of illness don't decrease. Activity doesn't need to be limited. c. denial c. Klonopin is a central nervous system (CNS) depressant and can aggravate symptoms in depressed clients. What steps should the     nurse take? a. Client teaching would include which of the following statements?     a. Now the client has a temperature of 102° F (38. 11. This guilt is referred to as survivor's guilt. The nurse also should teach the client to take haloperidol with meals ² not 1 hour before ² and should instruct the client not to decrease or increase the dosage unless the physician orders it. call the physician. Withhold the next dose of fluphenazine. Klonopin is a minor depressant and may aggravate symptoms of depression. Because haloperidol can cause photosensitivity and precipitate severe sunburn. a heart rate of 120 beats/minute. Blood dyscrasias aren't a common problem with MAOIs.MAOI antidepressants when combined with a number of drugs can cause life-threatening hypertensive crisis. During a discharge teaching session. It doesn't interact with organ meats and can be taken with antidepressant medication. Apply a sunscreen before being exposed to the sun. the nurse should instruct the client to apply a sunscreen before exposure to the sun. In repression. killing two of his friends. nurse Ericka should provide which instruction to the client?  a. Aspirin and NSAIDs are safe to take with MAOIs. administer an antipyretic agent. and a blood pressure of 210/140 mm Hg. In denial. 10 mg by mouth twice per day. Klonopin may interact with organ meats. Give the next dose of fluphenazine and restrict the client to the room to decrease stimulation. call the physician. an individual involuntarily blocks an unpleasant experience. repression Individuals who survive a traumatic experience in which others have died commonly report powerful feelings of guilt that they survived and others didn't. Withhold the next dose of fluphenazine. memory.a teenager was driving a car that slipped off an icy road. The client's behavior is an example of: a. A male client is about to be discharged with a prescription for the antipsychotic agent haloperidol (Haldol). a person refuses to accept that a situation or feeling exists. d. The order needs to be clarified. a client with chronic schizophrenia has received 10 mg of fluphenazine hydrochloride (Prolixin) by mouth four times per day. anticipatory grief d. and monitor vital signs. and monitor vital signs. The medications shouldn't be taken together. c. 12. Take the medication 1 hour before a meal. 10. Michael. c. There is no need to call the physician. b. b. and increase the client's fluid intake. d. the medications can be safely taken together. It's imperative that a client checks with his physician and pharmacist before taking any other medications. He repeatedly tells the     nurse that he should be dead instead of his friends.

Joe is admitted to a psychiatric facility with a diagnosis of chronic schizophrenia. chlorpromazine (Thorazine) b. 13. increased fluid intake is contraindicated because it may increase the client's fluid volume further. such as sexual comments and angry outbursts. a client with paranoid personality disorder is suspicious. appearance. 15. Avoidant personality disorder is characterized by anxiety. chlorpromazine and benztropine. neck. and arms. fear. To reduce psychotic symptoms    b. Why is benztropine administered?  a. lithium carbonate (Lithonate) d. face. however. or praise. The nurse should withhold the next dose. and amitriptyline is used for depression. She also manipulates the group with attention-seeking behaviors. 16.V. hostile. or control nausea and vomiting. haloperidol (Haldol) c. borderline personality disorder This client's behaviors are typical of histrionic personality disorder. cold. which is marked by excessive emotionality and attention seeking. To control nausea and vomiting d. paranoid personality disorder  b. and is uncomfortable except when she is the center of attention. and arms suggest tardive dyskinesia. Neuroleptic . it causes more pronounced sedation than haloperidol. unpredictable behavior and unstable. Joyce constantly interrupts with impulsive behavior and exaggerated stories that cast her as a hero or princess. Ryan would probably be ordered medication for the acutely aggressive schizophrenic client? a. Borderline personality disorder is characterized by impulsive. neck. relieve anxiety. During a group therapy session in the psychiatric unit. Nurse Joey realizes that these behaviors are typical of:  a. The client constantly seeks and demands attention. and social isolation. Dystonia c. and argumentative. an adverse reaction to neuroleptic medication.M. administered to reduce the extrapyramidal adverse effects of chlorpromazine and other antipsychotic medications. Which condition should the nurse suspect?  a. Dr. Akathisia Unusual movements of the tongue. and continue to monitor vital signs. histrionic personality disorder d. and back muscles. or conversation. Nurse Jason is teaching a psychiatric client about her prescribed drugs. neck. Assessment reveals unusual movements of the tongue. To relieve anxiety Benztropine is an anticholinergic medication. or I. intense interpersonal relationships. approval. The history indicates that the client has been taking neuroleptic medication for many years. is the drug of choice for acute aggressive psychotic behavior. Typically.Malignant neuroleptic syndrome is a dangerous adverse effect of neuroleptic drugs such as fluphenazine. Tardive dyskinesia    b. may be seductive in behavior. notify the physician. Although an antipyretic agent may be used to reduce fever. Benztropine doesn't reduce psychotic symptoms. 14. amitriptyline (Elavil)     Haloperidol administered I. avoidant personality disorder   c. raising blood pressure even higher. Chlorpromazine is also an antipsychotic drug. Dystonia is characterized by cramps and rigidity of the tongue. Neuroleptic malignant syndrome d. To reduce extrapyramidal symptoms c. Lithium carbonate is useful in bipolar or manic disorder.

the nurse helps the client learn how to interact with people in new situations. he is diagnosed with chronic undifferentiated schizophrenia. Disturbed thought processes. hypertension. with a 5-year history of multiple psychiatric admissions is brought to the emergency department by the police. fever. the nurse should:     a. tell the client specifically and concisely what needs to be done d. Urinary frequency isn't an approved nursing diagnosis. and jitteriness. manifested by the client's extreme withdrawal and attempt to protect himself from the environment. which nursing intervention is most appropriate?  a. Based on his previous medical records and current behavior. The nurse must act immediately to reduce anxiety and protect the client and others from possible injury. Risk for injury related to a severely decreased level of consciousness d. Impaired verbal communication. that warrant a nursing diagnosis of Ineffective protection related to blood dyscrasias. and diaphoresis. To help the client meet his basic needs. such as urine retention.malignant syndrome causes rigidity. 17. Nurse Jeremiah formulates a nursing diagnosis of Impaired verbal communication for a client with schizotypal personality disorder. eliminating option C. ask the client which activity he would prefer to do first b. These medications also have anticholinergic effects. Self-care deficient: Dressing/grooming For this client. Although antipsychotic medications may cause sedation. Helping the client to participate in social interactions  b. they don't severely decrease the level of consciousness. The other options are appropriate but should take place only after the nurse-client relationship is established. Urinary frequency related to adverse effects of antipsychotic medication c. 18. Establishing alternative forms of communication d. Allowing the client to decide when he wants to participate in verbal communication with the nurse By establishing a one-on-one relationship. Risk for injury related to electrolyte disturbances Antipsychotic medications may cause neutropenia and granulocytopenia. anxiety. shoeless. 20. dry mouth. Which nursing diagnosis may be appropriate for this client?     a. 19. These drugs don't cause electrolyte disturbances. Akathisia causes restlessness. are appropriate nursing diagnoses but aren't the highest priority. the highest-priority nursing diagnosis is Anxiety (severe to panic-level). evidenced by inability to understand the situation. Anxiety b. eliminating option D. Ineffective protection related to blood dyscrasias b. evidenced by a disheveled appearance. Kris with schizophrenia is receiving antipsychotic medication. Bryan. manifested by noncommunicativeness. negotiate a time when the client will perform activities c. and confused. and constipation. prepare the client ahead of time for the activity . Nurse Lea is providing care to a client with a catatonic type of schizophrenia who exhibits extreme negativism. Impaired verbal communication c. He was found wandering the streets disheveled. Nurse Tryzz should assign     highest priority to which nursing diagnosis? a. and Selfcare deficient: Dressing/grooming. Based on this nursing diagnosis. Establishing a one-on-one relationship with the client   c. life-threatening blood dyscrasias. Disturbed thought processes d.

in order of decreasing importance. 21. Encourage socialization with peers. What is the nurse's first priority?     a. the client must learn to deal with the hallucinations without relying on drugs. safety.  b.  d. but appear to depress the CNS by blocking the transmission of three neurotransmitters: dopamine. Assist the client with showering. rather than decrease. reassure the client and administer as needed lorazepam (Ativan) I. c. administer as needed dose of benztropine (Cogentin) by mouth as ordered. singing loudly may upset other clients and would be socially unacceptable after the client is discharged. Because the voices aren't likely to go away permanently. serotonin. sing loudly to drown out the voices and provide a distraction. Lorazepam treats anxiety. take an as-needed dose of psychotropic medication whenever they hear voices. the need for food is among the most important. d. . The nurse's first action is a. so sending the client to his room would increase.M. I. not extrapyramidal effects. practice saying "Go away" or "Stop" when they hear voices. Sedate the CNS by stimulating serotonin at the synaptic cleft. go to their room until the voices go away Researchers have found that some clients can learn to control bothersome hallucinations by telling the voices to go away or stop. Giving the client choices isn't desirable because he can be manipulative or refuse to do anything. Hallucinations are most bothersome in a quiet environment when the client is alone. Taking an as needed dose of psychotropic medication whenever the voices arise may lead to overmedication and put the client at risk for adverse effects. include hygiene. 23. to: Judah receiving haloperidol (Haldol) complains of a stiff jaw and difficulty swallowing.  b. and serotonin receptors. Other needs. norepinephrine.     The client is most likely suffering from muscle rigidity due to haloperidol. Depress the CNS by blocking the postsynaptic transmission of dopamine. serotonin. b. benztropine should be administered to prevent asphyxia or aspiration.The client needs to be informed of the activity and when it will be done. the hallucinations. Assist the client with feeding. and a sense of belonging. They don't sedate the CNS by stimulating serotonin. c. and norepinephrine. Stimulate the CNS by blocking postsynaptic dopamine.M. Aiza with paranoid schizophrenia has been experiencing auditory hallucinations for many years. Negotiating and preparing the client ahead of time also isn't therapeutic with this type of client because he may not want to perform the activity. administer as needed dose of haloperidol (Haldol) by mouth. Another dose of haloperidol would increase the severity of the reaction.   c. can't perform activities of daily living. and norepinephrine. Depress the CNS by stimulating the release of acetylcholine. The exact mechanism of antipsychotic medication action is unknown. 22. d.  c. One approach that has proven to be effective for hallucinating clients is to:  a. According to Maslow's hierarchy of needs. b. and they don't stimulate neurotransmitter action or acetylcholine release. Nurse Irma is aware that the most antipsychotic medications exert which of following effects on the central nervous system (CNS)?  a.M. Teresa with catatonic schizophrenia is mute. as ordered. d. 24. and stares out the window for hours. Although distraction is helpful. administer as needed dose of benztropine (Cogentin) I. Reassure the client about safety.

the nurse should try to verbalize the message conveyed by the client's nonverbal behavior. Which intervention should the nurse include in the client's plan of care?     a. the nurse's support and presence can be reassuring. Nurse isabel is assigned to a client with catatonic schizophrenia. Administering lithium carbonate (Lithonate) as prescribed d. however. not leave the client alone all the time. Despite the client's mute. Lithium is used to treat mania. the nurse must provide for all of these needs. Meeting all of the client's physical needs b. Providing a quiet environment where the client can be alone Because a client with catatonic schizophrenia can't meet physical needs independently. This client is incapable of expressing concerns. unresponsive state. not catatonic schizophrenia. the nurse should provide nonthreatening stimulation and should spend time with the client. exercise.25. and elimination. including adequate food and fluid intake. Although aware of the environment. Giving the client an opportunity to express concerns c. the client doesn't interact with it actively. .

The nurse observes that the client¶s anger is escalating. comb his hair 444 strokes. deny reality b. assign a staff to be with the client at all times to help maintain control The manic client is hyperactive and may engage in injurious activities. (Therapy may not completely extinguish certain behaviors. manipulate others Projection is a defense mechanism where one attributes ones feelings and inadequacies to others to reduce anxiety. Initiate confinement measures The proper procedure for dealing with harmful behavior is to first try to calm patient verbally. clear. Clients who are suspicious primarily use projection for which purpose: a. Option C. Allow ample time for the client to complete all rituals before each meal  d. 1. however only nondestructive methods of expression should be allowed. and switch thebathroom lights 44 times.     4. The nurse closely observes the client who has been displaying aggressive behavior. Option B. Option A. arrogant talked fast and hyperactive. Options C and D focuses on the self rather than others. to deal with feelings and thoughts that are not acceptable c. the goal is to systematically decrease the undesirable behavior. nurses set limit as needed. Options A. Before eating a meal. The correct answers have a green background while the incorrect ones have a red background. to show resentment towards others d. 3. When caring for a client with OCD. What is the most appropriate goal of care for this client?  a. seclusion or restraints may be applicable. Acknowledge the client¶s behavior  b. 2.Nursing Board Review: Psychiatric Nursing Practice Test Part 1 All the questions in the quiz along with their answers are shown below. A 26 year old writer is admitted for the second time accompanied by his wife. Systematically decrease the number of repetitions of rituals and the amount of time spent performing them. a female client with obsessive-compulsive disorder (OCD) must wash his hands for 18 minutes. B and C are appropriate approaches during the escalation phase of aggression. concise directions are given because of the distractibility of the client but this is not the priority. the manic client tend to externalize hostile feelings. Initially the nurse should plan this for a manic client:  a. Assigning a staff to be with the client at all times is not realistic. A quiet environment and consistent and firm limits should be set to ensure safety.) Expecting to omit one behavior each day is unrealistic because the client may have used ritualistic behavior would perpetuate the undesirable behavior. Assist the client to an area that is quiet  d. Which approach is least helpful for the client at this time?  a. Your answers are bolded. repeat verbal instructions as often as needed  c. allow the client to get out feelings to relieve tension  d. set realistic limits to the client¶s behavior  b. Maintain a safe distance from the client  c. Increase the client¶s acceptance of therapeutic drug use  c. When verbal and psychopharmacologic interventions are not adequate to handle the aggressiveness. Omit one unacceptable behavior each day  b. is not true in all instances of projection. . He is demanding. Option D.

Caparas is to: a.  b. instruct the client to keep an accurate record of food and fluid intake An anorexic client who requires hospitalization is in poor physical condition from starvation and may die as a result of arrhythmias. the nurse should plan to:  a. or cardiac abnormalities secondary to electrolyte imbalances. Blood pressure of 100/70 mm Hg d. During the initial phase of the nurse-patient relationship. Option A may worsen anxiety. The observation that the client has scratched wrists doesn't substantiate the other options. alleviating symptoms b. Risk for violence: Self-directed related to impulsive mutilating acts. To promote the client's physical health. monitoring the client's vital signs.   c. serum electrolyte levels. Blood pressure may be labile throughout withdrawal. A client is admitted to the psychiatric clinic for treatment of anorexia nervosa. c. d. and acid base balance is crucial. Hypertensiontypically occurs in early withdrawal. identifying problems. Based on this finding. serum electrolyte level. A client with borderline personality disorder is admitted to the psychiatric unit. All other responses aren¶t part of this phase of the relationship. tasks include establishing boundaries of the relationship. 8. the most helpful nursing intervention for Mrs. malnutrition. Risk for violence: Directed toward others related to verbal threats. The predominant behavioral characteristic of the client with borderline personality disorder is impulsiveness. She had been admitted withsevere depression. the nurse should formulate a nursing diagnosis of:  a. is a common sign of alcohol withdrawal. hypothermia. 6. assessing anxiety c. may occur in later stages. 9. Heart rate of 50 to 60 beats/minute c. Option B is incorrect because a weight obtained after breakfast is more accurate than one obtained after the evening meal. Hypotension is associated with cardiovascular collapse and most commonly occurs in clients who don't receive treatment. and identifying expectations. Ineffective individual coping related to feelings of guilt. The nurse should monitor the client's vital signs carefully throughout the entire alcohol withdrawal process. allow her to remain isolated in her room  . infection. Hypotension. weigh the client daily. d. Caparas is:     a. assessing anxiety levels.5. after the evening meal.    b. especially of a physically self-destructive sort. Situational low self-esteem related to feelings of loss of control. providing sympathy d. monitor vital signs. Daisy Caparas is a 35 year old woman with two young children. Initial nursing assessment reveals that the client's wrists are scratched from a recent suicide attempt. fluctuating at different stages. Therefore. setting limits During the initial phase of the nurse-patient relationship in this situation. Blood pressure of 140/80 mm Hg Tachycardia. the client may record food and fluid intake inaccurately. 7. and acid-base balance. Heart rate of 120 to 140 beats/minute     b. although rare during the early withdrawal stages. severely restrict the client's physical activities. Which assessment finding is most consistent with early alcohol withdrawal? a. The best way to promote communication with Mrs. also. Option D would reward the client with attention for not eating and reinforce the control issues that are central to the underlying psychological problem. a heart rate of 120 to 140 beats/minute.

Allowing the patient to decide when he wants to participate in verbal communication with you By establishing a one-to-one relationship. Providing self-care for him   c. The other options aren¶t recommended methods for promoting communication. 12. Eye exercises won¶t resolve the client¶s blindness because no organic pathology is causing the symptoms. To promote self-esteem. Helping the patient to participate in social interactions b. 11. 13.   b. This may be help her gain confidence in making assessments and decisions. Caparas regain self-awareness include: a. ask for clarification and restate or paraphrase her statements c. Parotid gland tenderness d. place strict time limits on her efforts at communication d. Coarse hair growth Frequent vomiting causes tenderness and swelling of the parotid glands. the nurse does one of the following: a. and it may encourage self-reliance. encouraging reflection Encouraging the patient to reflect enables her to think about the events and feelings and reach a conclusion. Blindness and other physical symptoms in a conversion disorder aren¶t under the client¶s control and are real to him. flushed extremities   c. Tachycardia  b. give positive reinforcement for what the client can do. Not focusing on his blindness  b. Soft. Establishing alternative forms of communication d. Which nursing intervention would be most appropriate for this client?  a. She¶s diagnosed as having conversion disorder and is admitted to the psychiatric unit. The nurse is assessing a 16-year-old female who is being admitted for treatment of anorexia nervosa. The client is arrogant and manipulative. 14. the nurse helps the patient learn how to interact with other people in new situations. Which clinical manifestation is the nurse most likely to find?  a. downlike hair (called lanugo) may cover the extremities. discouraging her assessment of emotions c. In ensuring a therapeutic milieu. The client should be encouraged to participate in his own care as much as possible to avoid fostering dependency. The reduced metabolism that occurs with severe weight loss produces bradycardia and cold extremities. tell her what you think is going on Asking for clarification and restating or paraphrasing the patient¶s statements are techniques used to further elicit and clarify the patient¶s feelings. Establishing a one-on-one relationship with the patient c. The nurse formulates a nursing diagnosis of ³impaired verbal communication´ for a male patient with schizotypal personality disorder. Agree on a consistent approach among the staff assigned to the client. Teaching eye exercises to strengthen his eyes Focusing on the client¶s blindness can positively reinforce the blindness and further promote the use of maladaptive behaviors to obtain secondary gains. Based on this nursing diagnosis. and face of an anorexic client. discouraging comparison with other episodes in her life b. Techniques that may help Mrs. 10. The other options are appropriate but should take place only after the nurse-patient relationship is established. A 27-year-old woman reports losing her sight in both eyes. encouraging her to cry as frequently as needed     d. which nursing intervention is most appropriate?     a. Warm. shoulders. Telling him that his blindness isn¶t real d.  .

This is a therapeutic way of to handle attempts of exploiting the weakness in others or create conflicts among the staff. this is not therapeutic because the client tends to control and dominate others. the nurse assumes which role with Mrs. A consistent firm approach is appropriate. a subjectively perceived threat c. others may perceive touch as human-boundary violation. Option C. talking phase d. d. Patients should never be touched. working phase During the orientation phase of the therapeutic relationship. Anxiety is caused by: a. Provide the client with extra time for one on one sessions d.   b. Touch has many meanings to patients. touching requires sensitivity on the part of the nurse. the first phase of nurse-patient interactions is known as the:  a. Gomez?     a. Option D. hostility turned to the self d. palilalia. Option B. mania is due to masked depression. echolalia. In a therapeutic relationship. Gomez. 19. a depressed client internalizes hostility. Apraxia is the inability to carry out motor activities. Bargaining should not be allowed. Suggest that the client take a leading role in the social activities c. Which statement about patient touch is true? a. 17. Helper d. allowing the client to negotiate may reinforce manipulative behavior. Although many patients are eager for human touch. Allow the client to negotiate the plan of care Agree on a consistent approach among the staff assigned to the client. the nurse and patient make an agreement that they will be working together to solve one or more of the patient¶s problems. aphonia. Option A. Listener A therapeutic relationship is a helping relationship. Option D. c. masked depression     Anxiety is caused by a subjectively perceived threat. Friend c. Therefore. 18. 16. 15. Doer b. d. c. Palilalia is defined as the repetition of sounds and words. Echolalia is the act of repeating the words of others. Option C. and aphonia is the inability to speak. Most patients prefer to be touched. helping phase    b. A vocal tic that involves repeating one's own sounds or words is known as:     a. b. . limits are set for interaction time.     b. She has been diagnosed with clinical depression. apraxia. Nurse-patient touching is an issue that requires sensitivity on the part of the nurse. orientation phase c. Most patients prefer not to be touched. an objective threat b. Jade Gomez is a 33 year old housewife. Fear is caused by an objective threat. Tourette syndrome is characterized by the presence of multiple motor and vocal tics. when beginning a therapeutic relationship with Mrs.

Cruz¶s marital relationship. asking his friends to encourage self-care b. Mild b. Which of the following is the most therapeutic nursing intervention?     a. both of which are components of a healthy self-esteem. the number one risk factor for suicide in adult woman is spousal abuse Information regarding the patient¶s relationship with her spouse is important because spousal abuse is the leading cause of attempted and actual suicides in adult women. Severe d. Winnie Cruz is a 33 year old woman who is admitted to the hospital for observation after she attempted suicide. 23. a 21 year old college student fell from a train and sustained a spinal cord injury. spouses are often the first to be aware of a potential suicide  b. is probably angry that she¶ll still alive     c. panic level of anxiety is characterized immobilization.20. Kevin demonstrating? a. but they are not as focused on fostering a healthy self-esteem. Teaching self-care measures and eliciting his peers to encourage him will be beneficial. He¶s in a spinal cord rehabilitation program and is refusing to do things for himself or practices in his prescribed program. The nurse includes a psychosocial assessment that includes Mrs. The nurse says to Kevin. ³I think in a few months I¶ll pick up where I left off. suicide attempts may adversely affect the marital relationship d. may try to commit suicide again d. moving him to a different hospital environment d. obviously hates her life Patients who have attempted suicide are at much higher risk for repeat attempts in the future. spouses may be able to intervene in future suicide attempts   c. enlisting him in the planning of his own care c. teaching him to perform self-care measures Encouraging a patient to be as independent as possible will promote self-reliance and self-confidence. Acceptance . Option D. An effective means of encouraging this independence is enlisting the patient in the planning of his won care. leaving him paralyzed below the waist. Panic The client¶s manifestations indicate severe anxiety. ability to concentrate and capable of problem solving. Option A. based on the nurse¶s knowledge that:  a. Kevin to a different hospital environment isn¶t indicated based on the data given. moderate muscle tension. 24. with rapid speech headache and inability to     focus with what the doctor was saying. alertness. is definitely depressed b.´ Mr. Moving Mr. increased rate of speech and difficulty in concentrating are noted in moderate anxiety. increased vital signs.´ Which stage of the grief process is  Mr. ³Tell me about your plans after hospitalization. The nurse assesses the level of anxiety as: a. Cruz is essential because she: a. Moderate c. periodic slow pacing. mild anxiety is manifested by slight muscle tension. Kevin replies. incoherence. slight fidgeting. Psychiatric follow-up for Mrs. feeling of being overwhelmed and disorganization 21. 22. Option B. Kevin.back in college doing what I was doing before. A 29 year old client newly diagnosed with breast cancer is pacing. One of Kevin¶s nursing diagnosis is self-esteem disturbance.

Denial is a coping mechanism that allows the individual time to assimilate the major changes associated with body function loss.   b. Which is the drug of choice for treating Tourette syndrome? a. Luvox. Prozac. Kevin is going through the grief-loss process because he has permanently lost the use of his legs due to paralysis. and Paxil are antidepressants and aren't used to treat Tourette syndrome. Anger c. 25. the first stage of the process. . paroxetine (Paxil) Haloperidol is the drug of choice for treating Tourette syndrome. Denial Mr. fluoxetine (Prozac) b. Bargaining d. His comment suggests that he¶s in denial. fluvoxamine (Luvox)     c. haloperidol (Haldol) d.

Midazolam would make this patient drowsy. Prochlorperazine and haloperidol are both capable of causing dystonia. also an antipsychotic agent.M. are rarely used to treat clients with chronic schizophrenia. What would be the most therapeutic response from the nurse?  a. 25 to 50 mg I. Chlorpromazine. How often must the nurse check the client¶s circulation? a. Every 2 hours Circulation as well as skin and nerve damage can occur within 15 minutes. "I recommend that you attend an Alcoholics Anonymous meeting. and range-of-motion exercises should be performed. Asking the client why he drove while intoxicated can make him feel defensive and intimidated. the nurse suggests that the client isn't capable of making decisions. Which of the following medications would the nurse in-charge expect the doctor to order to reverse a dystonic reaction?  a. Haloperidol (Haldol)  d. 3. or I. A nurse places a female client in full leather restraints. thus fostering dependency. which necessitates compliance with the dosage schedule. it¶s commonly prescribed for outpatients with a history of medication noncompliance. Midazolam (Versed) Diphenhydramine. Once per shift c. By giving advice. Because it has a 4-week duration of action."  c. 1.     4. It encourages the widest range of client responses.Nursing Board Review: Psychiatric Nursing Practice Test Part 2 All the questions in the quiz along with their answers are shown below. and lithium carbonate. The physician is most likely to prescribe which medication for this client?  a. a mood stabilizer. A male client with a history of medication noncompliance is receiving outpatient treatment for chronic undifferentiated schizophrenia. "You should know better than to drink and drive. or 8 hours isn¶t often enough and could result in permanent damage to the client¶s extremities. Imipramine (Tofranil)  c. Lithium carbonate (Lithane)  d. a tricyclic antidepressant. Diphenhydramine (Benadryl)  c. Chlorpromazine (Thorazine)  b. Imipramine. not reversing it. Checking every hour. Restraints should be removed every 2 hours."  d. Once per hour b. Your answers are bolded. The client tells the nurse he was involved in a car accident while he was intoxicated. A judgmental approach isn't therapeutic. makes the client an active participant in the conversation. 2 hours. . 2." An open-ended statement or question is the most therapeutic response. The correct answers have a green background while the incorrect ones have a red background. Fluphenazine decanoate (Prolixin Decanoate) Fluphenazine decanoate is a long-acting antipsychotic agent given by injection. must be administered daily to maintain adequate plasma levels. "Tell me how you feel about the accident. Every 10 to 15 minutes d. "Why didn't you get someone else to drive you?"  b..V. and shows the client that the nurse is interested in his feelings. Procholorperazine (Compazine)  b. would quickly reverse this condition.

and hypertension. Paranoid c. Option D. C. Individuals with paranoid personality demonstrate a pattern of distrust and suspiciousness and interprets others motives as threatening. Monitor respiratory status     c. Dystonia is manifested by torticollis and rolling back of the eyes. muscle rigidity.   c. Antisocial These are the characteristics of an individual with antisocial personality. begin after 7 days. Narcissistic    b. Option A. Pseudoparkinsonism c. and attention-seeking behaviors. Individuals with histrionic have excessive emotionality. . Which personality disorder is he likely to have?  a. Options A and C. begin anytime within the next 1 to 2 days. pill rolling tremors. Which of the following medical conditions is commonly found in clients with bulimia nervosa? a. engages in abusive behaviors and does not have a sense of remorse. tardive dyskinesia b. d. 7. Hepatitis A Bulimia nervosa can lead to many complications. Allergies b. The client on Haldol has pill rolling tremors and muscle rigidity. wormlike movement of the tongue. Option C. including diabetes. Document the client¶s response to the treatment A side effect of ECT which is life threatening is respiratory arrest. 6. Which is the highest priority in the post ECT care? a. begin within 2 to 7 days. place and person d. the nurse should expect early withdrawal symptoms to:  a. Tardive dyskinesia is manifested by lip smacking. akinesia     d. or hepatitis A. Narcissistic personality disorder is characterized by grandiosity and a need for constant admiration from others. not occur at all because the time period for their occurrence has passed. Akinesia is characterized by feeling of weakness and muscle fatigue. Confusion and disorientation are side effects of ECT but these are not the highest priority. Delirium tremens may occur 2 to 4 days ² even up to 7 days ² after the last drink.  b. Acute withdrawal symptoms from alcohol may begin 6 hours after the client has stopped drinking and peak 1 to 2 days later. Observe for confusion b. 8. B. A client tends to be insensitive to others. A. Reorient to time. Based on this response. 9. A client is being admitted to the substance abuse unit for alcohol detoxification. dystonia Pseudoparkinsonism is a side effect of antipsychotic drugs characterized by mask-like facies. As part of the intake interview. heart disease. He says that he had his last drink 6 hours before admission. Diabetes mellitus d. Histrionic d. The eating disorder isn't typically associated with allergies. He is likely manifesting: a. cancer. the nurse asks him when he had his last alcoholic drink.5. Cancer     c.

She received full thickness burn on 20% of her body in a house fire in which two of her children died. Delusions are false personal beliefs. Rather. these responses are not therapeutic because they are challenging and rejecting. ³If you want I can go naked for you. Which behavior would most suggest to the nurse that Mrs.     The nurse is caring for a male client with schizophrenia. 14.´  b. A client has approached the nurse asking for advice on how to deal with his alcohol addiction.´  c. fostering the ability to perform self-care independently is a desirable client outcome. The client replies. The client says to the nurse ´ Pray for me´ and entrusts her wedding ring to the nurse. Hopelessness indicates no alternatives available and may lead to suicide. threatening the client is not therapeutic. The client demonstrates the ability to meet his own self-care needs The client with schizophrenia is commonly socially isolated and withdrawn. Diana Gil is a 45 year old mother of three.10. psychotherapy. Putting up your sleeve is fine. Gil is still in the earliest stage of the grief process?   a. Because the client with schizophrenia may have difficulty meeting his or her own self-care needs. attendance at AA meetings. Psychotherapy. the statement and non verbal cue of the client indicate suicide. total abstinence. Questions about job retaining . Protecting the client and others from harm is a desirable client outcome achieved by close observation. 11. The nurse knows that this may signal which of the following:  a. 12. Options A and B. Major depression d. therefore. matter of fact way. The client doesn¶t harm himself or others d. ³I will report you to the guard if you don¶t control yourself. Reducing or eliminating delusional thinking using talking therapy and antipsychotic medications would be a desirable outcome.´ The most therapeutic response by the nurse is:  a. b. 13. ³You¶re attractive but I¶m not interested. removing any dangerous objects. Total abstinence is the only effective treatment for alcoholism. The nurse asks a client to roll up his sleeves so she can take his blood pressure.´  d. having the client spend more time by himself wouldn¶t be a desirable outcome. Option C. a desirable outcome would specify that the client spend more time with other clients and staff on the unit. The client spends more time by himself b. ³You wouldn¶t be the first that I will see naked. While suicide is common among clients with major depression. this occurs when their depression starts to lift.´ ³I only need access to your arm.´ The nurse needs to deal with the client with sexually connotative behavior in a casual. c. and aversion therapy are all adjunctive therapies that can support the client in his efforts to abstain. The client doesn¶t engage in delusional thinking c. ³I only need access to your arm. Putting up your sleeve is fine. Hopelessness The client¶s statement is a verbal cue of suicidal ideation not anxiety. Which outcome is the least desirable? a. and administering medications. Alcoholics Anonymous (AA). aversion therapy. Outburst of anger toward her family and the staff b. The nurse should tell the client that the only effective treatment for alcoholism is:     a. suicidal ideation c. is a patient on a burn unit. d. anxiety    b.

Lack of self-esteem. Panic d. Gil and provide assurance and safety. Last week. b. Flat affect. She exhibits screaming. 15. Use of restrains requires a doctors order and can cause injury to the skin and joints. Mrs. which nursing intervention is most appropriate? a. vigorous attempts to get out of the bed. Several days d. Several hours   c. Several minutes  b. strong dependency needs. How soon after chlorpromazine administration should the nurse in charge expect to see a patient¶s delusion thoughts and hallucinations eliminated?  a. therefore. and emotional coldness are seen in paranoid personality disorders. sexual acting out. Instability in interpersonal relationships. Suspiciousness. Encourage Mrs. disbelief and denial. statements such as ³it¶s a dream´ and ³it didn¶t really happen´ are expected reactions in that stage. the client can't tolerate being alone and expresses feelings of emptiness or boredom. Moderate c. Suspiciousness. and emotional coldness c. Gil remain in bed and apply soft wrist restrains. hypervigilance. Which nursing observations support this diagnosis? a. 16. her boyfriend broke up with her after she drove his car into a tree after an argument. Statements that ³it¶s a dream´ and ³it didn¶t really happen´ d. During this episode. Job retaining questions are more suggestive of either the acceptance phase or dysfunctional grief. Gil to express her feelings about the event.     When a patient is experiencing panic. Isolation is more suggestive of the depression phase of grief. In the lesser degree of anxiety. Gil. and unusual dress b. the patient¶s typical behavior is changed. hypervigilance. d. in which the individual is failing to grieve. These manifestations are most suggestive of which level of anxiety?     a. strong dependency needs. The     client's initial diagnosis is borderline personality disorder. and poor self-image also is common. Flat affect. Mild b.  c. Typically. Have Mrs. and impulsive behavior d. She says she has quit her last five jobs because her coworkers didn't like her and didn't train her adequately. and violence Borderline personality disorder is characterized by lack of self-esteem. Gil distorted response to the ambulance are indicative of panic. Anger is the second phase of grief. mood. Shortly after midnight. and unusual dress are characteristic of schizoid personality disorder. In antisocial personality disorder. During panic. but not exaggerated level that is seen in panic. it¶s most important for the nurse to remain with the patient to provide physical and verbal assurance as well as to protect her from further injury. Discuss appropriate coping mechanisms with Mrs. Stay with Mrs. clients are usually insensitive to others and act out sexually. 17. social withdrawal. and incoherent speech. Several weeks . teaching her to discuss her feelings is less appropriate intervention because they can agitate the patient even more. social withdrawal. Gil is awakened by the sound of an arriving ambulance outside the window of her room. Insensitivity to others. and impulsive behavior. crying. they may also be violent 18. c. Wanting to be left alone in a dark and quiet room Early grief involves shock. A 26 year old unemployed woman seeks help because she feels depressed and abandoned and doesn't know what to do with her life. Severe Extreme behaviors such as Mrs.

is key to establishing a therapeutic rapport with a patient. the nurse should make which of the following recommendations?   a. Options A and C encourage further delusions by denying poisoning and offering information related to the delusion. Empathy encourages a patient¶s trust and promotes the patient¶s self-expression. as in option D. I¶m not going to harm you. Ms. a 21 year old mother of premature newborn. 19. the understanding of another¶s perception of a situation. Consistent limits b. ³Why are you poisoning me? I know you work for central thought control! You can keep my thoughts. The prealcoholic phase is characterized by drinking to medicate feelings and for relief from stress. Give me back my soul!´ how should the nurse respond?  a. it¶s the most important aspect of the nursing role that should be expressed. Early alcoholic phase C. Validating the patient¶s feeling. their antipsychotic effects may take several weeks to appear. and preoccupation with alcohol. Moreno is expressing guilt about her son¶s illness.´    b. especially to place and person. The chronic phase is characterized by emotional and physical deterioration. The early phase is characterized by sneaking drinks. Role modeling d. Physical discipline     A structured lifestyle demonstrates acceptance and caring provides a sense of security.Although most phenothiazine produces some effects within minutes to hours. rapidly gulping drinks. Physical discipline can decrease self-esteem. It¶s against the nursing code of ethics. occurs during a later stage in the therapeutic process. Are you feeling angry today?´ The nurse should directly orient a delusional patient to reality. Dolores Moreno. a female patient with paranoid schizophrenia runs to the nurse and says. ³I¶m a nurse. During which phase of alcoholism is loss of control and physiologic dependence evident? A. Empathy b. ³I sense anger. Prealcoholic phase B. Conditions necessary for the development of a positive sense of self-esteem include: a. 23. ³I¶m a nurse.´ c. A client tells the nurse that he is having suicidal thoughts every day. In this situation. And how could I possibly steal your soul?´ d. Which aspect of her role should the nurse most express when addressing Ms. I¶m not poisoning you. Teaching Empathy. Guidance c. 21. Moreno¶s guilt?     a. Weekly outpatient therapy . smoked cigarettes during her pregnancy. A no-suicide contract b. Crucial phase     D. blackouts. Chronic phase The crucial phase is marked by physical dependence. Inconsistent boundaries d. 22. A critical environment erodes a person¶s esteem. Inconsistent boundaries lead to feelings of insecurity and lack of concern. ³I¶m not poisoning you. In conferring with the treatment team. Critical environment c. Her son is a patient in NICU and has a diagnosis of acute respiratory distress syndrome. 20. and you¶re a patient in the hospital. While pacing in the hall.

anxiety. What is the nurse's best response?  a. Do you want to tell me why you did that?" c. Intensive inpatient treatment Inpatient care is the best intervention for a client who is thinking about suicide every day. Flumazenil (Romazicon) has been ordered for a client who has overdosed on oxazepam (Serax). The effect is magnified if the client has a combined tricyclic antidepressant and benzodiazepine overdose." d. a client with borderline personality disorder asks the nurse to keep his secret and then displays multiple. "The team needs to know when something important occurs in treatment. "That's it! You're on suicide precautions.  c. 25. and chest pain. . I'm concerned about infection. Options A and B put the client on the defensive and may lead to a power struggle. Implementing a no-suicide contract is an important strategy. During a private conversation. A second psychiatric opinion d." This response informs the client of the nurse's planned actions and allows time to discuss the client's actions. the nurse should be prepared for which common adverse effect?  a. self-inflicted. Seizures  b. but this client requires additional care. Weekly therapy wouldn't provide the intensity of care that this case warrants. Shivering   c. Chest pain Seizures are the most common serious adverse effect of using flumazenil to reverse benzodiazepine overdose. "I'm going to tell your physician. Option C ignores the psychological implications of the client's actions. I need to tell the others."    b. superficial lacerations on the forearms. Less common adverse effects include shivering. Anxiety d. 24. Before administering the medication. this client requires immediate intervention. Obtaining a second opinion would take time. "Tell me what type of instrument you used. but let's talk about it first.

) c. This diagnosis reflects a belief that one is: a. Nurse Monet is caring for a female client who has suicidal tendency. Avoiding relationship . c. Marco approached Nurse Trish asking for advice on how to deal with his alcohol addiction. Allow her to urinate Open the window and allow her to get some fresh air Observe her 4. Highly famous and important Responsible for evil world Connected to client unrelated to oneself 7. Nurse Monet should« a. c. Psychotherapy b. Recurrent self-destructive behavior b. 2. Total abstinence d. Hallucinations Delusions Loose associations Neologisms 3. d. d. Being Killed b. c. Which behavior isnot most likely to be evidence of ineffective individual coping? a. c. A female client is admitted with a diagnosis of delusions of GRANDEUR. d.Psychiatric Nursing Practice Test Part 1 1. This perception is known as: a. The most appropriate nursing intervention should include? a. Which action should the nurse include in the plan? a. Turning on the television Leaving the client alone Staying with the client and speaking in short sentences Ask the client to play with other clients 6. Give her privacy b. Alcoholics anonymous (A. Nurse Trish should tell the client that the only effective treatment for alcoholism is: a. Aversion Therapy Nurse Hazel is caring for a male client who experience false sensory perceptions with no basis in reality. b. b. Provide privacy during meals b. A 20 year old client was diagnosed with dependent personality disorder. Encourage client to exercise to reduce anxiety Restrict visits with the family 5. When accompanying the client to the restroom. d. Set-up a strict eating plan for the client c. Nurse Maureen is developing a plan of care for a female client with anorexia nervosa. A client is experiencing anxiety attack. d.A.

the nurse priority nursing intervention for a newly admitted client with bulimia nervosa would be to? a. A 75 year old client is admitted to the hospital with the diagnosis of dementia of the Alzheimer¶s type and depression. Nurse Patricia is aware that the major health complication associated with intractable anorexia nervosa would be? a. The most appropriate initial goal for a client diagnosed with bulimia is? a. The symptom that is unrelated to depression would be? a. Assumes responsibility for her actions c. d. c. Encourage to avoid foods b. Which behavior by the client indicates adult cognitive development? a. Observe client during meals Monitor client continuously 14. Apathetic response to the environment b.c. Nurse Tony was caring for a 41 year old female client. Teach client to measure I & O b. ³I don¶t know´ answer to questions Shallow of labile effect Neglect of personal hygiene 13. Has maximum ability to solve problems and learn new skills d. 8. d. Respiratory difficulties Nausea and vomiting Dizziness Seizures 12. Showing interest in solitary activities Inability to make choices and decision without advise A male client is diagnosed with schizotypal personality disorder. Cardiac dysrhythmias resulting to cardiac arrest Glucose intolerance resulting in protracted hypoglycemia . d. The Nurse should carefully observe the client for? a. Paranoid thoughts b. b. d. b. A neuromuscular blocking agent is administered to a client before ECT therapy. Generates new levels of awareness b. c. Which signs would this client exhibit during social situation? a. Nurse Claire is caring for a client diagnosed with bulimia. Nurse Trish is working in a mental health facility. Identify anxiety causing situations c. d. d. Involve client in planning daily meal c. c. Eat only three meals a day Avoid shopping plenty of groceries 10. Emotional affect Independence need Aggressive behavior 9. Her perception are based on reality 11.

d. A 39 year old mother with obsessive-compulsive disorder has become immobilized by her elaborate hand washing and walking rituals. Shame Remorsefulness 20. d. Rationalization b. d. Mario is complaining to other clients about not being allowed by staff to keep food in his room. Naloxone (Narcan) Benzlropine (Cogentin) . Endocrine imbalance causing cold amenorrhea Decreased metabolism causing cold intolerance 15.c. increasing appropriate sensory perception ensuring constant client and staff contact 16. Allowing a snack to be kept in his room Reprimanding the client Ignoring the clients behavior Setting limits on the behavior 18. diaphoresis and hyperactivity. c. disorder is often: a. c. Conney with borderline personality disorder who is to be discharge soon threatens to ³do something´ to herself if discharged. Increasing stimulation b. Joey a client with antisocial personality disorder belches loudly. Cely is experiencing alcohol withdrawal exhibits tremors. d. Feelings of guilt and inadequacy d. Embarrassment c. Problems with being too conscientious b. Blood pressure is 190/87 mmhg and pulse is 92 bpm. Which of the following approaches would be most appropriate to use with a client suffering from narcissistic personality disorder when discrepancies exist between what the client states and what actually exist? a. ³Do you know why people find you repulsive?´ this statement most likely would elicit which of the following client reaction? a. Nurse Anna can minimize agitation in a disturbed client by? a. Ask a family member to stay with the client at home temporarily b. b. Which of the medications would the nurse expect to administer? a. Which of the following actions by the nurse would be most important? a. limiting unnecessary interaction c. b. A staff member asks Joey.C. Discuss the meaning of the client¶s statement with her Request an immediate extension for the client Ignore the clients statement because it¶s a sign of manipulation 19. Feeling of unworthiness and hopelessness 17. Problems with anger and remorse c. d. Consistency 21. Limit setting d. Depensiveness b. Nurse Trish recognizes that the basis of O. Supportive confrontation c. Which of the following interventions would be most appropriate? a.

b. c. Nurse Perry is aware that language development in autistic child resembles: a. Nurse Trish would expect a child with a diagnosis of reactive attachment disorder to: a. Have more positive relation with the father than the mother Cling to mother & cry on separation Be able to develop only superficial relation with the others Have been physically abuse 27. Role play life events to meet individual needs Use natural remedies rather than drugs to control behavior 26. Is short in duration & resolves easily Looks almost identical to adult depression 28. Restlessness & Irritability c. Yawning & diaphoresis b. d. Which of the following foods would the nurse Trish eliminate from the diet of a client in alcohol withdrawal? a. Does not respond to conventional treatment c. d. d. Milk b. d. Constipation & steatorrhea d. It may appear acting out behavior b. Encourage the staff to have frequent interaction with the client Share an activity with the client Give client feedback about behavior Respect client¶s need for personal space 25. d. Manipulate the environment to bring about positive changes in behavior b. d. When teaching parents about childhood depression Nurse Trina should say? a. b. c.c. d. b. To establish open and trusting relationship with a female client who has been hospitalized with severe anxiety. Which of the following would Nurse Hazel expect to assess for a client who is exhibiting late signs of heroin withdrawal? a. c. Allow the client¶s freedom to determine whether or not they will be involved in activities c. Nurse Monette recognizes that the focus of environmental (MILIEU) therapy is to: a. Lorazepam (Ativan) Haloperidol (Haldol) 22. Scanning speech Speech lag Shuttering Echolalia . the nurse in charge should? a. Soda Regular Coffee 23. Orange Juice c. Vomiting and Diarrhea 24.

Denial 30. Linda is pacing the floor and appears extremely anxious. Concretism 34. b. the client cannot remember facts and fills in the gaps with imaginary information. Positive body image . The duty nurse approaches in an attempt to alleviate Linda¶s anxiety. Excessive weight loss. Nurse Benjie is communicating with a male client with substance-induced persisting dementia. Flight of ideas b. Frequent regurgitation & re-swallowing of food b. Slow pulse. Projection c. d. c. Confabulation d. Avoidance of situation & certain activities that resemble the stress b. Sublimation d. Would you like me to talk with you? Are you feeling upset now? Ignore the client 32. A characteristic that would suggest to Nurse Anne that an adolescent may have bulimia would be: a. Nurse Trish should anticipate that a problem for this client would be? a. c. Nurse Joey is aware that the signs & symptoms that would be most specific for diagnosis anorexia are? a. Lack of interest in family & others Re-experiencing the trauma in dreams or flashback 33. excessive fears & nausea Excessive activity. When working with a male client suffering phobia about black cats. The nurse recognizes that the client is using the defense mechanism known as? a. Nurse Benjie is aware that this is typical of? a.29. d. amenorrhea & abdominal distension b. Previous history of gastritis c. Anxiety when discussing phobia Anger toward the feared object Denying that the phobia exist Distortion of reality when completing daily routines 31. Depression and a blunted affect when discussing the traumatic situation c. 10% weight loss & alopecia Compulsive behavior. A 60 year old female client who lives alone tells the nurse at the community health center ³I really don¶t need anyone to talk to´. Would you like to watch TV? b. d. c. Displacement b. Nurse Penny is aware that the symptoms that distinguish post traumatic stress disorder from other anxiety disorder would be: a. Associative looseness c. The most therapeutic question by the nurse would be? a. memory lapses & an increased pulse 35. d. The TV is my best friend. Badly stained teeth d.

Frustration & fear of death b. A long term goal for a paranoid male client who has unjustifiably accused his wife of having many extramarital affairs would be to help the client develop: a. A 23 year old client has been admitted with a diagnosis of schizophrenia says to the nurse ³Yes. Effective self boundaries d. A nursing care plan for a male client with bipolar I disorder should include: a. Low self esteem b. Weak ego 41. Nurse Monette is aware that extremely depressed clients seem to do best in settings where they have: a. These statement illustrate: a. Helps the client focus on the inability to deal with reality b. c. After detailed assessment. Helplessness & hopelessness 38. b. Is under the client¶s conscious control d. Better self control Feeling of self worth Faith in his wife 43. March is little woman´. To further assess a client¶s suicidal potential. When planning care for a female client using ritualistic behavior. Insight into his behavior b. a diagnosis of schizophrenia is made. Anxiety & loneliness d. Concrete thinking c. is brought to the psychiatric hospital by his parents. Routine Activities Minimal decision making Varied Activities 37. Nurse Gina must recognize that the ritual: a. d. A 32 year old male graduate student. c. The nurse uses which communication technique to encourage the client to eat dinner? . Multiple stimuli b. d.36. That¶s literal you know´. d. d. Providing a structured environment b. It is unlikely that the client will demonstrate: a. Is used by the client primarily for secondary gains 40. Anger & resentment c. Helps the client control the anxiety c. its march. Designing activities that will require the client to maintain contact with reality Engaging the client in conversing about current affairs Touching the client provide assurance 39. c. Neologisms Echolalia Flight of ideas Loosening of association 42. Nurse Katrina should be especially alert to the client expression of: a. A male client who is experiencing disordered thinking about food being poisoned is admitted to the mental health unit. who has become increasingly withdrawn and neglectful of his work and personal hygiene. c.

The nurse anticipates that what treatment procedure may be prescribed? a. ³You¶re having hallucination. During electroconvulsive therapy (ECT) the client receives oxygen by mask via positive pressure ventilation. Psychosurgery d. Electroconvulsive therapy . ³Abuser Are often jealous or self-centered´ ³Abuser use fear and intimidation´ ³Abuser usually have poor self-esteem´ 47. c. there are no spiders in this room at all´ ³I can see the spiders on the wall. When planning the discharge of a client with chronic anxiety. Ask the client direct questions to encourage talking b. Which statement by a group member would indicate a need to provide additional information? a. Rake the client into the dayroom to be with other clients c. Neuroleptic medication b. the client is found lying on the bed with a body pulled into a fetal position. b. but they are not going to hurt you´ ³Would you like me to kill the spiders´ ³I know you are frightened. d. Anesthesia is administered during the procedure b. Short term seclusion c. d. Nurse Chris evaluates achievement of the discharge maintenance goals. Focusing on self-disclosure of own food preference Using open ended question and silence Offering opinion about the need to eat Verbalizing reasons that the client may not choose to eat 44. Nurse Tina is caring for a client with delirium and states that ³look at the spiders on the wall´. c. Leave the client alone and continue with providing care to the other clients 45. Decrease oxygen to the brain increases confusion and disorientation c. Which goal would be most appropriately having been included in the plan of care requiring evaluation? a. Nurse Nina is assigned to care for a client diagnosed with Catatonic Stupor. When Nurse Nina enters the client¶s room. Nurse Tina is caring for a client with depression who has not responded to antidepressant medication. Nurse Nina should? a. Nurse Jonel is providing information to a community group about violence in the family. The client eliminates all anxiety from daily situations b. d. 48. What should the nurse respond to the client? a. The client identifies anxiety producing situations The client maintains contact with a crisis counselor 49. d. The nurse assisting with this procedure knows that positive pressure ventilation is necessary because? a. c. but I do not see spiders on the wall´ 46. Grand mal seizure activity depresses respirations Muscle relaxations given to prevent injury during seizure activity depress respirations. ³Abuse occurs more in low-income families´ b. Sit beside the client in silence and occasionally ask open-ended question d.a. b. d. The client ignores feelings of anxiety c.

Mario is admitted to the emergency room with drug-included anxiety related to over ingestion of prescribed antipsychotic medication.50. b. Length of time on the med. The most important piece of information the nurse in charge should obtain initially is the: a. Reason for the suicide attempt d. Name of the ingested medication & the amount ingested c. Name of the nearest relative & their phone number .

tactile or olfactory perceptions that have no basis in reality. gustatory. hoarding medications and talking about death. A. Neuromuscular Blocker. Total abstinence is the only effective treatment for alcoholism. 7. 2. An adult age 31 to 45 generates new level of awareness. 5. auditory. The Nurse should watch for clues. A. D. 17. staying with the client. D. A. 3. C. Appropriate nursing interventions for an anxiety attack include using short sentences. 8. repetitive. 24. 6. The nurse should discuss the client¶s statement with her to determine its meaning in terms of suicide. 23. 25. C. Hallucinations are visual. Bulimia disorder generally is a maladaptive coping response to stress and underlying issues. B. The nurse would specifically use supportive confrontation with the client to point out discrepancies between what the client states and what actually exists to increase responsibility for self. C. B. Delusion of grandeur is a false belief that one is highly famous and important. Ritualistic behavior seen in this disorder is aimed at controlling guilt and inadequacy by maintaining an absolute set pattern of behavior. Regular coffee contains caffeine which acts as psychomotor stimulants and leads to feelings of anxiety and agitation. Clients with schizotypal personality disorder experience excessive social anxiety that can lead to paranoid thoughts. decreasing stimuli. The nurse would most likely administer benzodiazepine. Environmental (MILIEU) therapy aims at having everything in the client¶s surrounding area toward helping the client. 18.Answers and Rationale Psychiatric Nursing Practice Test Part 1 1. these electrolytes are necessary for cardiac functioning. With depression. 4. A. 12. D. 21. Establishing a consistent eating plan and monitoring client¶s weight are important to this disorder. 22. such as SUCCINYLCHOLINE (Anectine) produces respiratory depression because it inhibits contractions of respiratory muscles. A consistent approach by the staff is necessary to decrease manipulation. 11. there is little or no emotional involvement therefore little alteration in affect. The natural tendency is to counterattack the threat to self image. D. B. along with muscle spasm. The nurse needs to set limits in the client¶s manipulative behavior to help the client control dysfunctional behavior. The client should identify anxiety causing situation that stimulate the bulimic behavior and then learn new ways of coping with the anxiety. These clients have severely depleted levels of sodium and potassium because of their starvation diet and energy expenditure. The Nurse has a responsibility to observe continuously the acutely suicidal client. A. D. A. 16. Serving coffee top the client may add to tremors or wakefulness. 13. and messages. fever. B. 14. Any suicidal statement must be assessed by the nurse. 20. C. B. 19. abdominal cramps and backache. B. therefore they must be carefully monitored. D. 10. such as lorazepan (ativan) to the client who is experiencing symptom: The client¶s experiences symptoms of withdrawal because of the rebound phenomenon when the sedation of the CNS from alcohol begins to decrease. . which increases anxiety. When the staff member ask the client if he wonders why others find him repulsive. C. A. the client is likely to feel defensive because the question is belittling. 9. such as communicating suicidal thoughts. 15. Vomiting and diarrhea are usually the late signs of heroin withdrawal. remaining calm and medicating as needed. Individual with dependent personality disorder typically shows indecisivenesssubmissiveness and clinging behavior so that others will make decisions with them. These clients often hide food or force vomiting. Limiting unnecessary interaction will decrease stimulation and agitation. D. nausea. Moving to a client¶s personal space increases the feeling of threat.

Weight loss is excessive (15% of expected weight). acting out behavior. D. 47. These are the major signs of anorexia nervosa. Children have difficulty verbally expressing their feelings. 45. The autistic child repeat sounds or words spoken by others. C. A. D. least stressful and least anxiety producing. C. Loose associations are thoughts that are presented without the logical connections usually necessary for the listening to interpret the message. 43. The nurse facilitates communication with the client by sitting in silence. B. Helping the client to develop feeling of self worth would reduce the client¶s need to use pathologic defenses. 42. 46. When hallucination is present. The nurse presence may provide the client with support & feeling of control. 50. Electroconvulsive therapy is an effective treatment for depression that has not responded to medication. Recognizing situations that produce anxiety allows the client to prepare to cope with anxiety or avoid specific stimulus.26. dependence. Structure tends to decrease agitation and anxiety and to increase the client¶s feeling of security. D. C. 49. 48. and require consistent. insecurity and jealousy. 29. A. 35. C. 33. D. Experiencing the actual trauma in dreams or flashback is the major symptom that distinguishes post traumatic stress disorder from other anxiety disorder. C. 34. Discussion of the feared object triggers an emotional response to the object. Children who have experienced attachment difficulties with primary caregiver are not able to trust others and therefore relate superficially 27. Confabulation or the filling in of memory gaps with imaginary facts is a defense mechanism used by people experiencing memory deficits. C. The rituals used by a client with obsessive compulsive disorder help control the anxiety level by maintaining a set pattern of action. repeated interventions. A. Communication with withdrawn clients requires much patience from the nurse. The expression of these feeling may indicate that this client is unable to continue the struggle of life. Personal characteristics of abuser include low self-esteem. . B. In an emergency. A person with this disorder would not have adequate self-boundaries. asking open-ended question and pausing to provide opportunities for the client to respond. D. 31. A. a defense that blocks problem by unconscious refusing to admit they exist. B. D. such as temper tantrums. D. Open ended questions and silence are strategies used to encourage clients to discuss their problem in descriptive manner. C. A. The name and the amount of medication ingested are of outmost important in treating this potentially life threatening situation. 44. lives saving facts are obtained first. Dental enamel erosion occurs from repeated self-induced vomiting. immaturity. B. Depression usually is both emotional & physical. 36. A simple daily routine is the best. 41. may indicate underlying depression. 32. Clients who are withdrawn may be immobile and mute. B. 28. the nurse should reinforce reality with the client. D. 40. 37. A short acting skeletal muscle relaxant such as succinylcholine (Anectine) is administered during this procedure to prevent injuries during seizure. 38. 30. The client statement is an example of the use of denial. 39.

2. Fresh fish c. Waiting until the client¶s family can participate in the client¶s care b. Which of the following approaches by the nurse would be the most therapeutic? a. Dogs eat dirt. ³Where is my daughter? I love Louis. Roasted chicken b. Wait for the client to begin the conversation 3. rain go away. which of the following approaches would the nurse expect to implement? a. Explaining the importance of hygiene to the client d. Termination phase when discharge plans are being made. Working phase when the client brings it up. Echolalia . d. For a male client with dysthymic disorder. Question the client until he responds b. Psychoanalysis d. The nurse in charge observes Joe to be in need of grooming and hygiene. Urine retention and blurred vision b. Respiratory depression and convulsion c. Antidepressant therapy 7. Initiate contact with the client frequently c. When teaching Mario with a typical depression about foods to avoid while taking phenelzine(Nardil). which of the following would alert the nurse to the possibility that the client is experiencing anticholinergic effects? a. Nurse Tony should first discuss terminating the nurse-client relationship with a client during the: a. ECT b. Danny who is diagnosed with bipolar disorder and acute mania. Malou is diagnosed with major depression spends majority of the day lying in bed with thesheet pulled over his head.´ The nurse interprets these statements as indicating which of the following? a. When assessing a female client who is receiving tricyclic antidepressant therapy. Asking the client if he is ready to take shower c. Joe who is very depressed exhibits psychomotor retardation. a flat affect and apathy. Rain. states the nurse. Stating to the client that it¶s time for him to take a shower 4. Hamburger 5. b. Orientation phase when a contract is established. Which of the following nursing actions would be most appropriate? a. Working phase when the client shows some progress. c. Tremors and cardiac arrhythmias 6. Salami d. Sit outside the clients room d. which of the following would the nurse in charge include? a. Delirium and Sedation d. Psychotherapeutic approach c.Psychiatric Nursing Practice Test Part 2 1.

Which of the following statements indicates to the nurse that the client is improving? a. Watching TV d. Paroxetine (Paxil) c. Leading group activity d.´ Which of the following would be the best response of the nurse? a. Which of the following would the nurse use to determine that the medication administered PRN have been most effective? . Cleaning dayroom tables c.´ c. which of the following methods of suicide would the nurse identify as most lethal? a. Reading a book 9. Using exercise bicycle b. which of the following medications would nurse Monet anticipate administering if the client developed extra pyramidal side effects? a. Lorazepam (Ativan) 13.Which of the following activities would the nurse in charge expect to include in Terry¶s plan of care? a. ³I couldn¶t kill myself because I don¶t want to go to hell. Flight of ideas 8.b. Head banging c. ³I don¶t think about killing myself as much as I used to. Neologism c. Jon a suspicious client states that ³I know you nurses are spraying my food with poison as you take it out of the cart. A client is suffering from catatonic behaviors. ³I¶m of no use to anyone anymore. Allowing the client to be the first to open the cart and get a tray 14. ³I know my kids don¶t need me anymore since they¶re grown. Reading comics 12.´ b. Wrist cutting b. Olanzapine (Zyprexa) b. Meditating c. Which of the following activities would Nurse Trish recommend to the client who becomes very anxious when thoughts of suicide occur? a.´ d. Use of gun d. Watching TV b. Aspirin overdose 10. Giving the client canned supplements until the delusion subsides b. Clang associations d. Jun has been hospitalized for major depression and suicidal ideation. Terry with mania is skipping up and down the hallway practically running into other clients. Benztropine mesylate (Cogentin) d. Asking what kind of poison the client suspects is being used c.´ 11. When assessing a male client for suicidal risk. Serving foods that come in sealed packages d. When developing the plan of care for a client receiving haloperidol.

Role playing c. Nurse Hazel invites new client¶s parents to attend the psycho educational program for families of the chronically mentally ill. Which of the following client¶s possession will the nurse most likely place in a locked area? a. Feeling more guilty about the client¶s illness c. Psychotic behavior is common during acute episodes b. Recognizing the client¶s weakness d. Prognosis for recovery is good with therapeutic intervention c. Shampoo c. The program would be most likely to help the family with which of the following issues? a. Scrap book making d. Nurse Trish would recommend which of the following activities for Tina? a. Tina with a histrionic personality disorder is melodramatic and responds to others and situations in an exaggerated manner. Being involved with primarily one to one activities 17. Managing their financial concern and problems 16. Toothpaste b. The individual typically remains in the mainstream of society. The individual usually seeks treatment willingly for symptoms that are personally distressful. Discussing his relationship with his mother b. The client walks with the nurse to her room d. Participating solely in group activities d. Which statement about an individual with a personality disorder is true? a. Asking him to explain reasons for his seductive behavior c. When planning care for Dory with schizotypal personality disorder. The client is able to move all extremities occasionally 15. Leading a sing a long in the afternoon c. 18. Antiseptic wash d. Nurse John is talking with a client who has been diagnosed with antisocial personality about how to socialize during activities without being seductive. Suggesting to apologize to others for his behavior d. Music group 20. Attending an activity with the nurse b. Explaining the negative reactions of others toward his behavior 19. The client responds to verbal directions to eat b. Moisturizer . which of the following would help the client become involved with others? a.a. Developing a support network with other families b. Baking class b. The client initiates simple activities without direction c. Nurse John would focus the discussion on which of the following areas? a. although he has problems in social and occupational roles d. Joy has entered the chemical dependency unit for treatment of alcohol dependency.

Tea c.Nurse Ronald would most likely prepare to administer which of the following medication? a. The nurse in charge interprets these findings as possibly indicating which of the following? a. After administering naloxone (Narcan). Delusion b. Nurse Trish would be especially alert for which of the following? a. Which of the following assessment would provide the best information about the client¶s physiologic response and the effectiveness of the medication prescribed specifically for alcohol withdrawal? a. The kinds of friends he makes d. Respiratory depression b. Vital signs 22. Mental alertness c. an opioid antagonist. Epilepsy c. The way he gets along with his parents b. Epilepsy b. Flash back d. Kidney failure d. Ativan d. Valium c. Jose is diagnosed with amphetamine psychosis and was admitted in the emergency room. Nutritional status d. Confusion 26. Respiratory failure 25. The number of drug-free days he has c.21. Cerebral edema 23. Haldol 27. The amount of responsibility his job entails 24. Cranberry Juice . Renal failure d. Which of the following liquids would nurse Leng administer to a female client who is intoxicated with phencyclidine (PCP) to hasten excretion of the chemical? a. Sleeping pattern b. Joey who has a chronic user of cocaine reports that he feels like he has cockroaches crawling under his skin. Librium b. Shake b. His arms are red because of scratching. Formication c. Myocardial Infarction c. A female client is brought by ambulance to the hospital emergency room after taking an overdose of barbiturates is comatose. Which of the following would nurse Ronald use as the best measure to determine a client¶s progress in rehabilitation? a. Nurse Ronald should monitor the female client carefully for which of the following? a.

Nurse Lhey would expect an adolescent client with anorexia to exhibit: a. Affective instability b. Joy¶s stream of consciousness is occupied exclusively with thoughts of her father¶s death. Assessing pain frequently 34. Telling the client to avoid details of the accident d. the nurse would expect to note the presence of: a.d. Postponing discussion of the accident until the client brings it up c. Shock and disbelief b. Which of the following would the nurse expect to initiate? a. Take the client a lunch tray and let the client eat in his room 30. Providing basic intellectual stimulation d. Restitution 32. Directing the individual¶s activities at this time c. Facilitating progressive review of the accident and its consequences b. Resolving the loss d. which is known as: a. Increased inhibitions d. The initial nursing intervention for the significant-others during shock phase of a grief reaction should be focused on: a. Developing awareness c. Staying with the individuals involved d. Presenting full reality of the loss of the individuals b. Mobilizing the individual¶s support system 31. Hyper vigilance 33. Arranging for long term custodial care c. Grape juice 28. Jerome who has eating disorder often exhibits similar symptoms.Nurse Ronald would direct the nursing assistant to do which of the following? a. Helping the client to evaluate her sister¶s behavior 29. Depersonalization and derealization . What is the priority care for a client with a dementia resulting from AIDS? a. When developing a plan of care for a female client with acute stress disorder who lost her sister in a car accident. unkempt physical appearance c.Nurse Ronald should plan to help Joy through this stage of grieving. Planning for remotivational therapy b. Invite the client to lunch and accompany him to the dining room c. Enhance intelligence c. The nursing assistant tells nurse Ronald that the client is not in the dining room for lunch. Accentuated premorbid traits b. Dishered. When taking a health history from a female client who has a moderate level of cognitive impairment due to dementia. Tell the client he¶ll need to wait until supper to eat if he misses lunch b. Inform the client that he has 10 minutes to get to the dining room for lunch d.

responding to imaginary companions and withdrawing to his room for several days at a time. Powerlessness related to the loss of idealized self c. When asking the parents about the onset of problems in young client with the diagnosis of schizophrenia. Grace is exhibiting withdrawn patterns of behavior. Eliminating defense mechanisms and phobia 40. Nurse Monette understands that the withdrawal is a defense against the client¶s fear of: a. Encourage his active participation in unit programs c. Recognizing each existing personality c. Repression b. There are a lot of other people on the unit who needs attention too.The client has been hearing voices. Provide foods. Isolate his gym time b. One morning a female client on the inpatient psychiatric service complains to nurse Hazel that she has been waiting for over an hour for someone to accompany her to activities. Anger d. A nursing diagnosis for a male client with a diagnosed multiple personality disorder is chronic low self-esteem probably related to childhood abuse. Reality reinforcement c. The primary nursing diagnosis for a female client with a medical diagnosis of major depression would be: a.´ This statement shows that the nurse¶s use of: a. Punishment d. Loneliness c. Repetitive motor mechanisms 35. Encourage his participation in programs 37. A 25 year old male is admitted to a mental health facility because of inappropriate behavior. Engaging in object-oriented activities d. Verbalizing the need for anxiety medications b. Limit-setting behavior d. Impulse control 39. fluids and rest d. Nurse Hazel replies to the client ³We¶re doing the best we can. The most appropriate short term client outcome would be: a. Impaired verbal communication related to depression 36. Rejection 41. Situational low self-esteem related to altered role b. Spiritual distress related to depression d. Phobia b. Powerlessness c. Nurse Linda would expect that they would relate the client¶s difficulties began in: .d. When developing an initial nursing care plan for a male client with a Bipolar I disorder (manic episode) nurse Ron should plan to? a. Nurse Johnny is aware that this type of behavior eventually produces feeling of: a. Paranoia 38. Defensive behavior b.

Nurse John recognizes that paranoid delusions usually are related to the defense mechanism of: a. Nurse Bea should: a. Attempting to hide from the nurse d. Physically ill and experiencing abdominal discomfort b. Adolescence d. Repression d. Puberty 42. Depersonalization c. Identification c. Invite the client to help decorate the dayroom b. Projection b. Early childhood b. forgetfulness and anxiety 44.Realizing that the client is hallucinating. The most accurate initial evaluation of the behavior would be that the client is: a. One morning. Echolalia 43. Nurse Mylene understands that the client tends to hallucinate more vividly: a. Somatic delusions b. regressed behavior and lack of social skills d. nurse Josie can anticipate: a. When planning care for a male client using paranoid ideation. Tell the client it is not good for him to talk to himself 46. nurse Jasmin should realize the importance of: a. Disorientation. a young female adult tells Nurse Mylene that the voices she hears frighten her. Jose who has been hospitalized with schizophrenia tells Nurse Ron. pessimistic out look and flight of ideas b. Withdrawal.a. Giving the client difficult tasks to provide stimulation b. Tired and probably did not sleep well last night c. arrogance and distractibility c. When being admitted to a mental health facility. During meal time c. nurse Diane finds a disturbed client curled up in the fetal position in the corner of the dayroom. Ask the client why he is smiling and talking d. Nurse Bea notices a female client sitting alone in the corner smiling and talking to herself. While watching TV b. In recognizing common behaviors exhibited by male client who has a diagnosis of schizophrenia. ³My heart has stopped and my veins have turned to glass!´ Nurse Ron is aware that this is an example of: a. Grandiosity. Feeling more anxious today 45. Leave the client alone until he stops talking c. After going to bed 47. Providing the client with activities in which success can be achieved . Slumped posture. During group activities d. Hypochondriasis d. Late childhood c. Regression 48.

c. Denial c. Irritability. Not placing any demands on the client 49. fever. Removing stress so that the client can relax d. Disorientation. profuse diaphoresis c. Within a few hours of alcohol withdrawal. Yawning. nurse John should assess the male client for the presence of: a. convulsions . Projection d. anxiety. Nurse Gerry is aware that the defense mechanism commonly used by clients who are alcoholics is: a. jerky movements d. tachycardia b. Tremors. Compensation 50. Displacement b. heightened alertness. paranoia.

³It¶s time for a shower´. dry mouth & constipation. The nurse would explain the negative reactions of others towards the client¶s behaviors to make the clients aware of the impact of his seductive behaviors on others. these individuals make marginal adjustments and remain in society. Dysthymia is a less severe. Because these disorders are enduring and evasive and the individual is inflexible. Using exercise bicycle is appropriate for the client who becomes very anxious when thoughts of suicidal occur. C. negative feelings about the future. 3. D. A crucial factor is determining the lethality of a method is the amount of time that occurs between initiating the 4. 2. B. This will positively affect the client¶s self-esteem. The statement ³I don¶t think about killing myself as much as I used to. A. The client with depression is preoccupied.Answers and Rationale Psychiatric Nursing Practice Test Part 2 1. 6. 11. 5. Client with dysthymic disorder benefit from psychotherapeutic approaches that assist the client in reversing the negative self image. prognosis for recovery is unfavorable. 13. B. Anticholinergic effects. which result from blockage of the parasympathetic (craniosacral) nervous system including urine retention. Flight of ideas is speech pattern of rapid transition from topic to topic. although they typically experience relationship and occupational problems related to their inflexible behaviors. D. When the nurse and client agree to work together. D. blurred vision. They provide education about the biochemical etiology of psychiatric disease to reduce. although it can occur in either schizotypal personality disorder or borderline personality disorder. Psychoeducational groups for families develop a support network. 16. and is unable to make decisions. C. The client with schizotypal personality disorder needs support. aged. 18. C. An individual with personality disorder usually is not hospitalized unless a coexisting Axis I psychiatric disorder is present. kindness & gentle suggestion to improve social skills & interpersonal relationship. frequent contacts throughout the day to let the client know that he is important to the nurse. B. The drug of choice for a client experiencing extra pyramidal side effects from haloperidol (Haldol) is benztropine mesylate (cogentin) because of its anti cholinergic properties. Generally. D. not increase family guilt. 15. C. Although all the actions indicate improvement. thereby dispelling the delusion. a contract should be established. chronic depression diagnosed when a client has had a depressed mood for more days than not over a period of at least 2 years. acute episodes do not occur. those that are fermented. 10. Distress can occur based on other people¶s reaction to the individual¶s behavior. The client with mania is very active & needs to have this energy channeled in a constructive task such as cleaning or tidying the room. A. It is common in mania. C. the ability to initiate simple activities without directions indicates the most improvement in the catatonic behaviors. often without finishing one idea. B. pickled. 17. and assists the client with personal hygiene to preserve his dignity and self-esteem. method & the delivery of the lethal impact of the method. the individual does not seek treatment because he does not perceive problems with his own behavior. Attending activity with the nurse assists the client to become involved with others slowly. Allowing the client to be the first to open the cart & take a tray presents the client with the reality that the nurses are not touching the food & tray. 8. C. The nurse should initiate brief. Foods high in tyramine. Psychotic behavior is usually not common. or smoked must be avoided because when they are ingested in combination with MAOIs a hypertensive crisis will occur.´ Indicates a lessening of suicidal ideation and improvement in the client¶s condition. A. D. 14. . The nurse presents the situation. has decreased energy. Personality disorders are chronic lifelong patterns of behavior. Generally. 12. the length of the relationship should be discussed in terms of its ultimate termination. 9. 7.

unless labeling clearly indicates that the product does not contain alcohol. The longer the client is free of drugs. secondary gain. Regression is a way of responding to overwhelming anxiety. 31. Individuals with anorexia often display irritability. C. The nurse will definitely give the client with PCP intoxication cranberry juice to acidify the urine to a ph of 5. 39. C. Antiseptic mouthwash often contains alcohol & should be kept in locked days he has. 26. A. This action maintains for as long as possible. 22. detached. withdrawn posture is a means of protecting the self by withdrawing and maintaining a safe. 30. The withdrawn pattern of behavior presents the individual from reaching out to others for sharing the isolation produces feeling of loneliness. drawn attention to self. 34. C. B. An acid environment aids in the excretion of PCP. 40. and is unaware of and does not deal with feelings. C. 37. and is associated with cocaine use. dependency and reinforcement of negative behavior while maintaining the client¶s worth. continuous process until a mental image of the dead person.5 & accelerate excretion.19. 42. Monitoring of vital signs provides the best information about the client¶s overall physiologic status during alcohol withdrawal & the physiologic response to the medication used. and rest. C. The nurse would prepare to administer an antipsychotic medication such as Haldol to a client experiencing amphetamine psychosis to decrease agitation & psychotic symptoms. A. A. 25. A moderate level of cognitive impairment due to dementia is characterized by increasing dependence on environment & social structure and by increasing psychologic rigidity with accentuated previous traits & behaviors. 35. including delusions. D. and a depressed mood. This client dramatizes events. B. these needs are a priority to ensure adequate nutrition. C. 23. The client in a manic episode of the illness often neglects basic needs. 21. The nurse instructs the nursing assistant to invite the client to lunch & accompany him to the dinning room to decrease manipulation. the clients intellectual functions by providing an opportunity to use them. 36. The nurse works to help the client clarify true feelings & learn to express them appropriately. D. fluid. painful. The best measure to determine a client¶s progress in rehabilitation is the number of drug. B. D. The fetal position represents regressed behavior. 24. Barbiturates are CNS depressants. hospitality. The feeling of bugs crawling under the skin is termed as formication. 28. B. . 38. 43. 27. 32. 29. D. Somatic delusion is a fixed false belief about one¶s body. This provides support until the individuals coping mechanisms and personal support systems can be immobilized. The nurse would facilitate progressive review of the accident and its consequence to help the client integrate feelings & memories and to begin the grieving process. After administering naloxone (Narcan) the nurse should monitor the client¶s respiratory status carefully. The nurse would use role-playing to teach the client appropriate responses to others and in various situations. A. The usual age of onset of schizophrenia is adolescence or early childhood. B. A. hallucinations & cognitive impairment. C. The client must recognize the existence of the sub personalities so that interpretation can occur. Respiratory failure is the most likely cause of death from barbiturate over dose. Resolving a loss is a slow. 41. The nurse¶s response is not therapeutic because it does not recognize the client¶s needs but tries to make the client feel guilty for being demanding. Depressed clients demonstrate decreased communication because of lack of psychic or physical energy. D. almost devoid of negative or undesirable features emerges. B. These are the classic behaviors exhibited by clients with a diagnosis of schizophrenia. emotional distance. the better the prognosis is. the nurse would be especially alert for the possibility of respiratory failure. A. 20. 33. An aloof. D. 44. C. because the drug is short acting & respiratory depression may recur after its effects wear off.

Auditory hallucinations are most troublesome when environmental stimuli are diminished and there are few competing distractions. D. Alcohol is a central nervous system depressant. B. 49.45. seeming to come from outside the self rather than from within. Denial is a method of resolving conflict or escaping unpleasant realities by ignoring their existence. B. These symptoms are the body¶s neurologic adaptation to the withdrawal of alcohol. 47. . B. This will help the client develop self-esteem and reduce the use of paranoid ideation. 50. 46. 48. Projection is a mechanism in which inner thoughts and feelings are projected onto the environment. This provides a stimulus that competes with and reduces hallucination. C. A.

Confusion c. Francis who is addicted to cocaine withdraws from the drug. drowsiness d. Suspicion d. A tentative diagnosis of opiate addiction. dilated pupils. vomiting. When assessing the situation. Esophageal varices 3. Projection . Joy who has just experienced her second spontaneous abortion expresses anger towards her physician. When working with children who have been sexually abused by a family member it is important for the nurse to understand that these victims usually are overwhelmed with feelings of: a. Current plans to commit suicide c. papillary constriction. Rhinorrhea. constipation c. Hatred 7. Hostility b. yawning 4. Inadequacy c. nurse Maureen should recognize that the rapist is motivated by feelings of: a. Lacrimation. A past history of depression b. subnormal temperature b. Self blame d. Hyperactivity b. Extra pyramidal tract symptoms d. Nausea. Delirium 2.Psychiatric Nursing Practice Test Part 3 1. The primary nursing intervention at this time would be to assess for: a. the nurse recognizes that the client may be using the coping mechanism of: a. Acute fluid and electrolyte imbalances c. The presence of marital difficulties d. Muscle aches. Depression c. Nurse Candy should assess a recently hospitalized client for signs of opiate withdrawal. These signs would include: a. Feelings of excessive failure 5. Humiliation b. The client¶s wife states that he lost his job several months ago and has been unable to find another job. Before helping a male client who has been sexually assaulted. Incompetence d. convulsions. Passion 6. A 48 year old male client is brought to the psychiatric emergency room after attempting to jump off a bridge. the hospital and the ³rotten nursing care´. Nurse John is aware that a serious effect of inhaling cocaine is? a. Deterioration of nasal septum b. Nurse Ron should expect to observe: a.

Apologizes for disrupting the unit¶s routine when something is needed b. Developmental theory d. Client is encouraged to talk about personal problems d. Jealous delusion b. Underlying unconscious conflict 9. angry client was effective if the client: a. Insight therapy to determine the origin of the anxiety and fear 12. Psychotherapy aimed at rearranging maladaptive thought process b.b. An attachment to odd objects c. Nurse Ronald could evaluate that the staff¶s approach to setting limits for a demanding. An interest in music b. Available situational supports b. When nurse Hazel considers a client¶s placement on the continuum of anxiety. In the diagnosis of a possible pervasive developmental autistic disorder. Perceptual field b.´ This statement indicates a: a. Creativity level 13. Reaction formation 8. These groups are successful because the: a. Crisis intervention worker is a psychologist and understands behavior patterns b. Delusional system c. Malou with schizophrenia tells Nurse Melinda. No longer calls the nursing staff for assistance 11. Ritualistic behavior d. Crisis group supplies a workable solution to the client¶s problem c. Understands the reason why frequent calls to the staff were made c. Nurse John is aware that the therapy that has the highest success rate for people with phobias would be: a. Displacement c. Somatic delusion . ³My intestines are rotted from worms chewing on them. Systematic desensitization using relaxation technique d. Denial d. Responsiveness to the parents 14. Memory state d. Nurse Trish suggests a crisis intervention group to a client experiencing a developmental crisis. The most critical factor for nurse Linda to determine during crisis intervention would be the client¶s: a. Willingness to restructure the personality c. a key in determining the degree of anxiety being experienced is the client¶s: a. Discuss concerns regarding the emotional condition that required hospitalizations d. Client is assisted to investigate alternative approaches to solving the identified problem 10. Psychoanalytical exploration of repressed conflicts of an earlier development phase c. The nurse would find it most unusual for a 3 year old child to demonstrate: a.

Delusion of persecution 15. Doxepin (Sinequan) d. Don¶t take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) b. Initial interventions for Marco with acute anxiety include all except which of the following? a. Have blood levels screened weekly for leucopenia c. PROPRANOLOL (Inderal) is used in the mental health setting to manage which of the following conditions? a. detachment and lack of tender feelings b. A common physiological response to stress and anxiety is: a. During an acute panic attack. Touching the client in an attempt to comfort him b. confident manner c. Delusion of grandeur d.c. quiet and private place 21. Don¶t take prescribed or over the counter medications without consulting the physician 19. Andy is admitted to the psychiatric unit with a diagnosis of borderline personality disorder. Antipsychotic ± induced akathisia and anxiety b. Decreased perceptual field c. Encouraging the client to verbalize feelings and concerns d. Inability to function as responsible parent d. The manic phase of bipolar illness as a mood stabilizer 17. Approaching the client in calm. Delusions for clients suffering from schizophrenia d. Decreased cardiac rate d. Obsessive ± compulsive disorder (OCD) to reduce ritualistic behavior c. Kris may experience: a. Uticaria b. Decreased respiratory rate 20. Somatic symptoms c. Avoid strenuous activity because of the cardiac effects of the drug d. Coldness. Nurse Jessie is assessing a client suffering from stress and anxiety. Kris periodically has acute panic attacks. Which medication can control the extra pyramidal effects associated with antipsychotic agents? a. Diarrhea . These attacks are unpredictable and have no apparent association with a specific object or situation. Providing the client with a safe.Nurse Hilary should expects the assessment to reveal: a. Clorazepate (Tranxene) b. Vertigo c. Sedation d. Which of the following statements should be included when teaching clients about monoamine oxidase inhibitor (MAOI) antidepressants? a. Unpredictable behavior and intense interpersonal relationships 16. Amantadine (Symmetrel) c. Heightened concentration b. Perphenazine (Trilafon) 18.

Decreased urine output d. General anesthesia b. Which nursing action is most appropriate when trying to diffuse a client¶s impending violent behavior? a. Figs and cream cheese b. ³Where do you hurt?´ 27. When performing a physical examination on a female anxious client. Jose who is receiving monoamine oxidase inhibitor antidepressant should avoid tyramine. Leaving the client alone until he can talk about his feelings c. Hyperactive bowel sounds c. Neurologic examination d. age 85. Helping the client identify and express feelings of anxiety and anger 26. Constipation 23. Which of the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD)? a. Severe anxiety and fear b. Erlinda. Tony with agoraphobia has been symptom-free for 4 months. Fruits and yellow vegetables c. Nursing preparation for a client undergoing electroconvulsive therapy (ECT) resemble those used for: a. When assessing the client immediately after ECT. ³Do you hurt? (pause) ³Do you hurt?´ c. with major depression undergoes a sixth electroconvulsive therapy (ECT) treatment. ³Can you describe your pain?´ d. ³Where is your pain located?´ b. a compound found in which of the following foods? a. Involving the client in a quiet activity to divert attention d. Classic signs and symptoms of phobia include: a. Place the client in seclusion b. Withdrawal and failure to distinguish reality from fantasy c. Rosana is in the second stage of Alzheimer¶s disease who appears to be in pain. Green leafy vegetables 29. Chlordiazepoxide (Librium) and diazepam (valium) c. Divalproex (depakote) and Lithium (lithobid) b.22. the nurse expects to find: . nurse Nelli would expect to find which of the following effects produced by the parasympathetic system? a. Muscle tension b. Fluvoxamine (Luvox) and clomipramine (anafranil) d. Benztropine (Cogentin) and diphenhydramine (benadryl) 24. Insomnia and inability to concentrate 25. Aged cheese and Chianti wine d. Depression and weight loss d. Physical therapy 28. Which question by Nurse Jenny would best elicit information about the pain? a. Cardiac stress testing c.

Involvement of family and support systems c. Restrict fluids and sodium intake b. dilated pupils and incomplete BP b. Sexual dysfunction 31. Permanent long-term memory loss and hypomania c. Emotional lability. Decreased dopamine level b. Reason for inpatient admission d. Stabilization of serotonin d. Which information should the community health nurse assess first during the initial follow-up with this client? a. Permanent short-term memory loss and hypertension b. Transitory short-term memory loss and permanent long-term memory loss d. Instruction that amenorrhea is irreversible 34. Which signs would suggest an overdose of an antianxiety agent? a. euphoria and impaired memory 32. Income level and living arrangements b. Reason for refusal to take medications 35. Discontinue if dry mouth and blurred vision occur d. Occurrence of incomplete libido due to medication adverse effects c.a. Don¶t consume alcohol c. Transitory short and long term memory loss and confusion 30. Increased acetylcholine level c. Combativeness. Polyuria b. A client refuses to remain on psychotropic medications after discharge from an inpatient psychiatric unit. Constipation d. Important teaching for women in their childbearing years who are receiving antipsychotic medications includes which of the following? a. Suspiciousness. Barbara with bipolar disorder is being treated with lithium for the first time. The nurse understands that the therapeutic effects of typical antipsychotic medications are associated with which neurotransmitter change? a. Continuing previous use of contraception during periods of amenorrhea d. Restrict fluid and sodium intake 33. Seizures c. sweating and confusion d. Which of the following best explains why tricyclic antidepressants are used with caution in elderly patients? . Nurse Fred is assessing a client who has just been admitted to the ER department. hyperactivity and grandiose ideation c. Nurse Clint should observe the client for which common adverse effect of lithium? a. Discharge instructions for a male client receiving tricyclic antidepressants include which of the following information? a. Stimulation of GABA 36. Increased incidence of dysmenorrhea while taking the drug b. Agitation.

Evidence of difficult relationships in the work environment 40. A client with depression has been hospitalized for treatment after taking a leave of absence from work. Interpersonal framework d. Serotonin syndrome effects 37. The nurse understands that this approach will do which of the following? a.a. The client has decreased episodes of impulsive behaviors c. Faulty thought processes that govern behavior d. Central Nervous System effects b. Cardiovascular system effects c. A client with a phobic disorder is treated by systematic desensitization. The client¶s statements indicate no remorse for behaviors . Help the client substitutes one fear for another d. A nurse who explains that a client¶s psychotic behavior is unconsciously motivated understands that the client¶s disordered behavior arises from which of the following? a. The client¶s employer expects the client to return to work following inpatient treatment. The nurse describes a client as anxious. Anxiety is a response to a threat 41. Help the client decrease anxiety 42. Psychodynamic framework 38. Abnormal thinking b. Psychiatric care in this treatment plan is based on which framework? a. Behavioral framework b. Gastrointestinal system effects d. Help the client execute actions that are feared b. The client makes statements of self-satisfaction d. Anxiety is usually pathological b. The client exhibits charming behavior when around authority figures b. Learned behavior b. Which client outcome would best indicate successful treatment for a client with an antisocial personality disorder? a. According to cognitive theory. Internal needs d. Help the client develop insight into irrational fears c. Response to stimuli 39. Anxiety is directly observable c. Which of the following statement about anxiety is true? a. The client tells the nurse. these statements reflect: a. Cognitive framework c. A client with depressive symptoms is given prescribed medications and talks with his therapist about his belief that he is worthless and unable to cope with life. Punitive superego and decreased self-esteem c. Anxiety is usually harmful d. ³I¶m no good. Altered neurotransmitters c. I¶m a failure´.

Disturbed body image c. Reading a self-help book on depression d. Pathophysiology of disease process b. Which activity should the nurse recommend to help this client express himself? a. Which nursing diagnosis is most appropriate for a client with anorexia nervosa who expresses feelings of guilt about not meeting family expectations? a. Which information should the nurse teach the client to help foster a sense of control over his symptoms? a. The parents clearly verbalize their expectations for the client c. The client verbalizes that family meals are now enjoyable d. A nurse is evaluating therapy with the family of a client with anorexia nervosa. Principles of good nutrition c. Stress management techniques 44. Deny that the situation is hopeless d. The nurse is caring for a client with an autoimmune disorder at a medical clinic. Present a cheerful attitude 48. The nurse plan to refer the client to a day treatment program in order to help him with: a. A client with major depression has not verbalized problem areas to staff or peers since admission to a psychiatric unit. Defensive coping d. The client lives in a boarding home. Which of the following is the most distinguishing feature of a client with an antisocial personality disorder? a. Which of the following would indicate that the therapy was successful? a. Social skills training . Managing his hallucinations b. and has little social interaction. Bizarre mannerisms and thoughts c. Medication teaching c. Powerlessness 46. Art therapy in a small group b. Side effects of medications d. The parents reinforced increased decision making by the client b. How can the nurse best respond using a cognitive approach? a. where alternative medicine is used as an adjunct to traditional therapies. The client tells her parents about feelings of low-self esteem 47.43. Disregard for social and legal norms 45. Basketball game with peers on the unit c. Submissive and dependent behavior d. The home health psychiatric nurse visits a client with chronic schizophrenia who was recently discharged after a prolong stay in a state hospital. Challenge the accuracy of the client¶s belief c. Agree with the client¶s painful feelings b. A client with dysthymic disorder reports to a nurse that his life is hopeless and will never improve in the future. Watching movie with the peer group 49. Attention to detail and order b. reports no family involvement. Anxiety b.

Watching TV in the dayroom . Which activity would be most appropriate for a severely withdrawn client? a. Board game with a small group of clients c.d. Art activity with a staff member b. Team sport in the gym d. Vocational training 50.

becoming more focused on self. C.Answers and Rationale Psychiatric Nursing Part 3 1. A. causes destruction of the mucous membranes of the nose. insect manifestations. Whether there is a suicide plan is a criterion when assessing the client¶s determination to make another attempt. The emergency nurse must establish rapport and trust with the anxious client before using therapeutic touch. involuntary muscle movements. B. These adaptations are associated with opiate withdrawal which occurs after cessation or reduction of prolonged moderate or heavy use of opiates.Ambivalence results in self-blame and also guilt. A client with borderline personality displays a pervasive pattern of unpredictable behavior. 11. A. Amantadine is an anticholinergic drug used to relive drug-induced extra pyramidal adverse effects such as muscle weakness. the client experiences a decrease in the perceptual field. C. B. 17. Propranolol is a potent beta adrenergic blocker and producing a sedating effect. 21. A. The client¶s anger over the abortion is shifted to the staff and the hospital because she is unable to deal with the abortion at this time. . internal parasites and misshapen parts. 20. 3. D. The parasympathetic nervous system would produce incomplete G. 7. During panic attack. mood and self image. 6. B. Somatic delusions focus on bodily functions or systems and commonly include delusion about foul odor emissions. C. 22. less aware of surroundings and unable to process information from the environment. 23. Perceptual field is a key indicator of anxiety level because the perceptual fields narrow as anxiety increases. possibly leading to diarrhea. Interpersonal relationships may be intense and unstable and behavior may be inappropriate and impulsive. It¶s imperative that a client checks with his physician and pharmacistbefore taking any other medications. Cocaine is a chemical that when inhaled. MAOI antidepressants when combined with a number of drugs can cause life-threatening hypertensive crisis. A. Touching an anxious client may actually increase anxiety.I. 4. A. 19. Personal internal strength and supportive individuals are critical factors that can be employed to assist the individual to cope with a crisis. 16. 15. Crisis intervention group helps client reestablish psychologic equilibrium by assisting them to explore new alternatives for coping. Panic is the most severe level of anxiety. pseudoparkinsonism and tar dive dyskinesia. 2. D. These children often have nonsexual needs met by individual and are powerless to refuse. There is little or no extension to the external environment. B. There is no set of symptoms associated with cocaine withdrawal. This would document that the client feels comfortable enough to discuss the problems that have motivated the behavior. 18. B. 14. motility resulting in hyperactive bowel sounds. B. D. 5. D. B. 9. The decreased perceptual field contributes to impaired attention and inability to concentrate. 8. The most successful therapy for people with phobias involves behavior modificationtechniques using desensitization. Diarrhea is a common physiological response to stress and anxiety. D. 12. Rapists are believed to harbor and act out hostile feelings toward all women through the act of rape. It considers realistic situations using rational and flexible problem solving methods. C. 13. therefore it is used to treat antipsychotic induced akathisia and anxiety. only the depression that follows the high caused by the drug. A. One of the symptoms of autistic child displays a lack of responsiveness to others. The antidepressants fluvoxamine and clomipramine have been effective in the treatment of OCD. 10. D.

euphoria and impaired memory. When speaking to a client with Alzheimer¶s disease. Those that the client can answer with ³yes´ or ³no´ whenever possible and avoid questions that require the client to make choices. the nurse should use close-ended questions. The client may not understand the purpose for the medication. The nurse providing follow-up care would have access to the client¶s medical record and should already know the reason for inpatient admission.24. Therefore. not cognitive theory. It rarely results in permanent short and long term memory loss. D. The typical antipsychotics act to block dopamine receptors and therefore decrease the amount of neurotransmitter at the synapses. 40. others and the world that impact functioning and contribute to symptoms. In many instances. D. and involvement of family and support systems are relevant issues following determination of the client¶s reason for refusing medication. The typical antipsychotics do not increase acetylcholine. D. Such statement as ³What happened to get you this angry?´ may help the client verbalizes feelings rather than act on them. Anxiety is a response to a threat arising from internal or external stimuli. Issues involving learned behavior are best explored through behavior theory. Drinking alcohol can potentiate the sedating action of tricyclic antidepressants. but hey are not applicable to this situation. The remaining side effects would apply to any client taking a TCA and are not particular to an elderly person. The other answer choices are frameworks for care. 34. B. and thus have significant cardiovascular side effects. Phobias cause severe anxiety (such as panic attack) that is out of proportion to the threat of the feared object or situation. A. The first are for assessment would be the client¶s reason for refusing medication. 30. Issues involving ego development are the focus of psychoanalytic theory. 35. 29. . B. 37. Signs of anxiety agent overdose include emotional lability. which is reversible. Polyuria commonly occurs early in the treatment with lithium and could result in fluid volume deficit. 31. Repeating the question aids comprehension. 28. tachycardia and elevated B. The TCAs affect norepinephrine as well as other neurotransmitters. The remaining responses do not address the internal forces thought to motivate behavior. A. Much of what motivates behavior comes from the unconscious. The patient¶s income level. Women may experience amenorrhea. especially in geriatric clients. Cognitive thinking therapy focuses on the client¶s misperceptions about self. Option 4 is incorrect because there is no evidence in this situation that the client has conflictual relationships in the work environment. D. stabilize serotonin. 38. or may be concerned about the cost of medicine. while taking antipsychotics. A.P. Dry mouth and blurred vision are normal adverse effects of tricyclic antidepressants. living arrangements. Using medications to alter neurotransmitter activity is a psychobiologic approach to treatment. behavior arises from internal wishes or needs. 27. stimulate GABA. 26. Aged cheese and Chianti wine contain high concentrations of tyramine. 36. C. According to this perspective. In any case. C. the client can still be pregnant. B. The concept that behavior is motivated and has meaning comes from the psychodynamic framework. The nurse should prepare a client for ECT in a manner similar to that for general anesthesia. 33. Physical signs and symptoms of phobias include profuse sweating. Excess dopamine is thought to be the chemical cause for psychotic thinking. ECT commonly causes transitory short and long term memory loss and confusion. A.Amenorrhea doesn¶t indicate cessation of ovulation thus. C. C. The client is demonstrating faulty thought processes that are negative and that govern his behavior in his work situation ± issues that are typically examined using a cognitive theory approach. the nurse can diffuse impending violence by helping the client identify and express feelings of anger and anxiety. 39. D. B. they are used with caution in elderly clients who may have increased risk factors for cardiac problems because of their age and other medical conditions. may be experiencing distressing side effects. poor motor control. the nurse cannot provide appropriate intervention before assessing the client¶s problem with the medication. 25. 32.

Therefore. The nurse can address the remaining answer choices in her teaching about the client¶s disease and treatment. A. The best approach with a withdrawn client is to initiate brief. The family¶s acceptance of the client¶s ability to make independent decisions is key to successful family intervention. This approach gives the nurse an opportunity to establish a trusting relationship with the client. Art therapy provides a nonthreatening vehicle for the expression of feelings. however. by changing his thinking. without experiencing anxiety. Use of cognitive techniques allows the nurse to help the client recognize that this negative beliefs may be distortions and that. There is no attempt to promote insight with this procedure. . B. Watching movie with a peer group does not guarantee that interaction will occur. Submissive and dependent behaviors are characteristic of someone with a dependent personality. Often. This will afford the client an increased sense of control over his symptoms. persistent mental illness training in social skills. Although management of hallucinations and medication teaching may also be part of the program offered in a day treatment. Day treatment programs provide clients with chronic. Bizarre mannerisms and thoughts are characteristics of a client with schizoid or schizotypal disorder. such as meeting and greeting people. D. he can adopt more positive beliefs that are realistic and hopeful. 45. and the client will not be taught to substitute one fear for another. the client may remain isolated. Agreeing with the client¶s feelings and presenting a cheerful attitude are not consistent with a cognitive approach and would not be helpful in this situation. Basketball is a competitive game that requires energy. Systematic desensitization is a behavioral therapy technique that helps clients with irrational fears and avoidance behavior to face the thing they fear. therefore. 42. B.41. Although the client¶s anxiety may decrease with successful confrontation of irrational fears. the client with major depression is not likely to participate in this activity. Charming behavior when around authority figures and statements indicating no remorse are examples of symptoms typical of someone with this disorder and would not indicate successful treatment. which in turn will help reduce the physiologic stress response. however this is not a characteristic of a client with antisocial personality disorder. Attention to detail and order is characteristic of someone with obsessive compulsive disorder. A. The client with anorexia typically feels powerless. nondemanding activities on a one-to-one basis. A client with antisocial personality disorder typically has frequent episodes of acting impulsively with poor ability to delay self-gratification. the client described in this situation would not be a candidate for this service. asking questions or directions. they would not necessarily indicate a successful outcome. placing an order in a restaurant. not decrease his isolation. decreased frequency of impulsive behaviors would be evidence of improvement. C. Denying the client¶s feelings is belittling and may convey that the nurse does not understand the depth of the client¶s distress. D. Vocational training generally takes place in a rehabilitation facility. and use of a small group will help the client become comfortable with peers in a group setting. A board game with a group clients or playing a team sport in the gym may overwhelm a severely withdrawn client. parental expectations and standards are quite high and lead to the clients¶ sense of guilt over not measuring up. In autoimmune disorders. the central family issues of dependence and independence are not addresses on these responses. Selfsatisfaction would be viewed as a positive change if the client expresses low self-esteem. the purpose of the procedure is specifically related to performing activities that typically are avoided as part of the phobic response. Although the remaining options may occur during the process of therapy. knowledge alone will not help the client to manage his stress effectively enough to control symptoms. taking turns in a group setting activity. 47. 43. Stress management techniques can help the client reduce the psychological response to stress. 46. 50. A. 49. the nurse is referring the client in this situation because of his need for socialization skills. 48. stress and the response to stress can exacerbate symptoms. with a sense of having little control over any aspect of life besides eating behavior. Recommending that the client read a self-help book may increase. 44. A. Disregard for established rules of society is the most common characteristic of a client with antisocial personality disorder. One of the core issues concerning the family of a client with anorexia is control. Watching TV is a solitary activity that will reinforce the client¶s withdrawal from others. D.

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